Provider Demographics
NPI:1093365900
Name:CARROLL, MARCUS
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:
Last Name:CARROLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 KEMPER MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-4117
Mailing Address - Country:US
Mailing Address - Phone:513-331-1987
Mailing Address - Fax:
Practice Address - Street 1:1108 KEMPER MEADOW DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-4117
Practice Address - Country:US
Practice Address - Phone:513-331-1987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator