Provider Demographics
NPI:1598721078
Name:CARROLL, JAMES E (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
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 1:16 DANFORTH ST
Mailing Address - Street 2:
Mailing Address - City:HOOSICK FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12090-1226
Mailing Address - Country:US
Mailing Address - Phone:518-686-5770
Mailing Address - Fax:518-686-7751
Practice Address - Street 1:16 DANFORTH ST
Practice Address - Street 2:
Practice Address - City:HOOSICK FALLS
Practice Address - State:NY
Practice Address - Zip Code:12090-1226
Practice Address - Country:US
Practice Address - Phone:518-686-5770
Practice Address - Fax:518-686-7751
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0006978207Q00000X
NY153835-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0005850Medicaid
NY01240019Medicaid
NY01240019Medicaid
NYBB8755Medicare ID - Type Unspecified
VT0005850Medicaid