Provider Demographics
NPI:1427189174
Name:CARROLL PRIMARY CARE, PA
Entity Type:Organization
Organization Name:CARROLL PRIMARY CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V. PRESIDENT, CARROLL PRIMARY CARE
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:MCEVOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-798-1888
Mailing Address - Street 1:1380 PROGRESS WAY
Mailing Address - Street 2:SUITE 114
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6464
Mailing Address - Country:US
Mailing Address - Phone:410-795-1888
Mailing Address - Fax:410-795-3538
Practice Address - Street 1:1380 PROGRESS WAY
Practice Address - Street 2:SUITE 114
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6464
Practice Address - Country:US
Practice Address - Phone:410-795-1888
Practice Address - Fax:410-795-3538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD208571200Medicaid
MD208571200Medicaid