Provider Demographics
NPI:1114386869
Name:MARIANNE CARROLL DO PA
Entity Type:Organization
Organization Name:MARIANNE CARROLL DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAIN / OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:T
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-891-3763
Mailing Address - Street 1:120 S OLIVE AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5501
Mailing Address - Country:US
Mailing Address - Phone:561-557-9998
Mailing Address - Fax:561-557-9989
Practice Address - Street 1:120 S OLIVE AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-5501
Practice Address - Country:US
Practice Address - Phone:561-557-9998
Practice Address - Fax:561-557-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9775207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty