Provider Demographics
NPI:1568064079
Name:CARROLL OCCUPATIONAL HEALTH, LLC
Entity Type:Organization
Organization Name:CARROLL OCCUPATIONAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-566-3258
Mailing Address - Street 1:PO BOX 37581
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3581
Mailing Address - Country:US
Mailing Address - Phone:240-566-3011
Mailing Address - Fax:240-566-3171
Practice Address - Street 1:700B CORPORATE CENTER CT STE A
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-3035
Practice Address - Country:US
Practice Address - Phone:410-871-0470
Practice Address - Fax:410-871-0743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherNOT APPLICABLE