Provider Demographics
NPI:1326794546
Name:CARROLL, GERALDINE M
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:M
Last Name:CARROLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 RUNNING DEER DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:PA
Mailing Address - Zip Code:17922-9361
Mailing Address - Country:US
Mailing Address - Phone:570-640-1607
Mailing Address - Fax:
Practice Address - Street 1:2121 RUNNING DEER DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:PA
Practice Address - Zip Code:17922-9361
Practice Address - Country:US
Practice Address - Phone:570-640-1607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA83445881335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier