Provider Demographics
NPI:1043240708
Name:CARROLL FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:CARROLL FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:G
Authorized Official - Last Name:UGGOWITZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-239-0406
Mailing Address - Street 1:814 HOUCKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-1882
Mailing Address - Country:US
Mailing Address - Phone:410-239-0406
Mailing Address - Fax:410-239-0407
Practice Address - Street 1:814 HOUCKSVILLE RD
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074-1882
Practice Address - Country:US
Practice Address - Phone:410-239-0406
Practice Address - Fax:410-239-0407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD10112104OtherCIGNA
MD4508793OtherAETNA MC/PPO/EPO
MD11071OtherPREFERRED HEALTH NETWORK
MDE289OtherBC/BS FED/BLUE CHOICE
MD0877346OtherAETNA US HEALTHCARE
MDKC91CAOtherBC/BS PAR/PPN/POS
MDMAMSIOther250778
MDCN 7035OtherRAILROAD MEDICARE
MD4508793OtherAETNA MC/PPO/EPO