Provider Demographics
NPI:1235294489
Name:CARROLL HEALTH GROUP LLC
Entity Type:Organization
Organization Name:CARROLL HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-848-1818
Mailing Address - Street 1:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-0900
Mailing Address - Country:US
Mailing Address - Phone:410-848-1818
Mailing Address - Fax:410-876-3159
Practice Address - Street 1:295 STONER AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5698
Practice Address - Country:US
Practice Address - Phone:410-848-1818
Practice Address - Fax:410-876-3156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1286701OtherAETNA
1544512OtherGATEWAY HEALTH PLAN
357439OtherHEALTH AMERICA