Provider Demographics
NPI:1578523791
Name:CARROLL, MARION LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARION
Middle Name:LOUIS
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:PO BOX 2048
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36652-2048
Mailing Address - Country:US
Mailing Address - Phone:251-432-4117
Mailing Address - Fax:251-436-7765
Practice Address - Street 1:424 S WILSON AVE
Practice Address - Street 2:
Practice Address - City:PRICHARD
Practice Address - State:AL
Practice Address - Zip Code:36610
Practice Address - Country:US
Practice Address - Phone:251-452-1442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00003960207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51035283OtherBCBS
AL631410085Medicaid
AL631411085Medicaid
AL51035281OtherBCBS
AL631400085Medicaid
AL631405085Medicaid
AL51035284OtherBCBS
AL51095854OtherBCBS
ALC73142OtherHEALTH SPRINGS OF AL
AL51035280OtherBCBS
AL51505924OtherBCBS
AL51505926OtherBCBS
AL51507026OtherBCBS
AL631404085Medicaid
AL631407085Medicaid
AL000000764Medicare PIN
AL51035280OtherBCBS