Provider Demographics
NPI:1144600016
Name:CARROLL, JAMES ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ANDREW
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHILDRENS PL MSC 8116-0043-08
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:314-454-6148
Mailing Address - Fax:314-454-4633
Practice Address - Street 1:1 CHILDRENS PL MSC 8116-0043-08
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110
Practice Address - Country:US
Practice Address - Phone:314-454-6148
Practice Address - Fax:314-454-4633
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE30497208000000X
390200000X
MO2022015510208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program