Provider Demographics
NPI:1417355777
Name:CARROLL COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:CARROLL COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BPWR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-876-4800
Mailing Address - Street 1:290 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5219
Mailing Address - Country:US
Mailing Address - Phone:410-876-4977
Mailing Address - Fax:410-876-4988
Practice Address - Street 1:290 S CENTER ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5219
Practice Address - Country:US
Practice Address - Phone:410-876-4977
Practice Address - Fax:410-876-4988
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF MARYLAND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-18
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1242525251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD12758022050OtherRELATED NPI NUMBER
MD423303400Medicaid