Provider Demographics
NPI:1134310667
Name:CAROLAN, OWEN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:OWEN
Middle Name:JOSEPH
Last Name:CAROLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1640 ROUTE 88
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3068
Mailing Address - Country:US
Mailing Address - Phone:732-458-7777
Mailing Address - Fax:732-458-6741
Practice Address - Street 1:1640 ROUTE 88
Practice Address - Street 2:SUITE 203
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3068
Practice Address - Country:US
Practice Address - Phone:732-458-7777
Practice Address - Fax:732-458-6741
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08284800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ119107XG4Medicare PIN