Provider Demographics
NPI:1275612459
Name:CARROLL INTERNAL MEDICINE ASSOCIATES LLC
Entity Type:Organization
Organization Name:CARROLL INTERNAL MEDICINE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-848-2449
Mailing Address - Street 1:291 STONER AVE STE 203
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5659
Mailing Address - Country:US
Mailing Address - Phone:410-848-2449
Mailing Address - Fax:410-848-2798
Practice Address - Street 1:291 STONER AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5647
Practice Address - Country:US
Practice Address - Phone:410-848-2449
Practice Address - Fax:410-848-2798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD31660174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKH04CAOtherBCBS OF MARYLAND
MDKH04CAOtherBCBS OF MARYLAND