Provider Demographics
NPI:1033732581
Name:CARROLL, KEVIN ANDREW SCOTT II (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ANDREW SCOTT
Last Name:CARROLL
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 PARK AVENUE APT 2J
Mailing Address - Street 2:
Mailing Address - City:BAYSHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:678-800-4317
Mailing Address - Fax:
Practice Address - Street 1:301 E MAIN ST.
Practice Address - Street 2:
Practice Address - City:BAYSHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:678-800-4317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2022-03-05
Deactivation Date:2022-01-17
Deactivation Code:
Reactivation Date:2022-03-05
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program