Provider Demographics
NPI:1467428987
Name:CARROLL, DANIEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:D
Last Name:CARROLL
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 1:105 W STONE DR
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3365
Mailing Address - Country:US
Mailing Address - Phone:423-408-7220
Mailing Address - Fax:423-408-7405
Practice Address - Street 1:2202 N JOHN B DENNIS HWY STE 204
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-5904
Practice Address - Country:US
Practice Address - Phone:423-224-3300
Practice Address - Fax:423-378-5324
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047148207Q00000X
TN19714207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3047223Medicaid
VA005609895Medicaid
TN1518004Medicaid
VAVVG464B288Medicare PIN
TN103I086971Medicare PIN
VA005609895Medicaid
E40669Medicare UPIN
TN1518004Medicaid
TN103I082933Medicare PIN