Provider Demographics
NPI:1407841042
Name:KAROL, IAN G (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:G
Last Name:KAROL
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 CORPORATE DR STE 325
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6295
Mailing Address - Country:US
Mailing Address - Phone:203-696-3642
Mailing Address - Fax:203-337-9731
Practice Address - Street 1:1 CORPORATE DR STE 325
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6295
Practice Address - Country:US
Practice Address - Phone:203-696-3642
Practice Address - Fax:203-337-9731
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT361642085B0100X
CT0361642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001361641-P2OtherBLUE CARE FAMILY PLAN
CTANC1162OtherOXFORD HEALTH PLANS
CTOV9113OtherHEALTH NET
CT001361641Medicaid
CT500HBX051CT01OtherBCBS CT
CT2069098OtherUNITED HEALTHCARE
CT061613357OtherCIGNA CT
CT0086989OtherAETNA CT
CT300128152OtherRAILROAD MEDICARE
CT001361641-P2OtherBLUE CARE FAMILY PLAN
CT300003083Medicare ID - Type Unspecified