Provider Demographics
NPI:1184684151
Name:CARROLL, BRIAN HURD (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:HURD
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-1354
Mailing Address - Fax:704-384-1374
Practice Address - Street 1:1918 RANDOLPH RD
Practice Address - Street 2:SUITE 275
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1100
Practice Address - Country:US
Practice Address - Phone:704-384-1354
Practice Address - Fax:704-384-1374
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047815207Q00000X
NC2008-00321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA80940002OtherCAREFIRST
VA288719OtherMAMSI
VA0181106OtherUNITED HEALTHCARE
VA246966OtherONE HEALTH PLAN
VA383306OtherBCBS ANTHEM
VA505653OtherNCPPO
VA4315337OtherAETNA
NC5909648Medicaid
VA5615747Medicaid
VA383306OtherBCBS ANTHEM
VA505653OtherNCPPO
NC5909648Medicaid