Provider Demographics
NPI:1043374960
Name:CARROLL, DENNIS GERARD (RN)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:GERARD
Last Name:CARROLL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 VIRGINIA RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2718
Mailing Address - Country:US
Mailing Address - Phone:978-318-8952
Mailing Address - Fax:978-318-9789
Practice Address - Street 1:696 VIRGINIA RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2718
Practice Address - Country:US
Practice Address - Phone:978-318-8952
Practice Address - Fax:978-318-9789
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA173250163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management