Basic Information
| Provider Information | |||||||||
| NPI: | 1245240753 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARLSON | ||||||||
| FirstName: | RIMA | ||||||||
| MiddleName: | BETH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 547 | ||||||||
| Address2: | CENTRAL VERMONT MEDICAL CENTER - FINANCE DEPT | ||||||||
| City: | BARRE | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056410547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022234738 | ||||||||
| FaxNumber: | 8022236067 | ||||||||
| Practice Location | |||||||||
| Address1: | 156 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MONTPELIER | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056022702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022234738 | ||||||||
| FaxNumber: | 8022236067 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 12/04/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0420012034 | VT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | RC081912 | 01 | MI | BLUE CROSS STATE ID | OTHER | 0C16002 | 01 | MI | MEDICARE GROUP | OTHER | 1017996 | 05 | VT | MEDICAID | 104917201 | 05 | MI | MEDICAID |