Provider Demographics
NPI:1568425668
Name:CARROLL, MARION (MD)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 HOMEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-1420
Mailing Address - Country:US
Mailing Address - Phone:216-228-6526
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-844-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060690207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000212469OtherUNISON
OH000000503545OtherANTHEM
OH363398OtherWELLCARE MEDICAID
OH742629OtherBUCKEYE MEDICAID
OH000000379823OtherANTHEM
OH4405802OtherAETNA
OH0823238Medicaid
OHN363376OtherWELLCARE
OHP00382874OtherRAILROAD MEDICARE
OHP00382874OtherRAILROAD MEDICARE
OH000000379823OtherANTHEM
OH4405802OtherAETNA
OH0823238Medicaid
OHCA4169957Medicare PIN