Provider Demographics
NPI:1639134448
Name:ESTEP, CARROL H (MD)
Entity Type:Individual
Prefix:DR
First Name:CARROL
Middle Name:H
Last Name:ESTEP
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 1:7700 WASHINGTON VILLAGE DR STE 260
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4097
Mailing Address - Country:US
Mailing Address - Phone:937-435-9013
Mailing Address - Fax:937-435-1458
Practice Address - Street 1:7700 WASHINGTON VILLAGE DR STE 160
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4094
Practice Address - Country:US
Practice Address - Phone:937-435-9013
Practice Address - Fax:937-435-1458
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35038376E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0305020Medicaid
OH0425882Medicare PIN
OHA75687Medicare UPIN
OH0425886Medicare PIN
080024402Medicare PIN
OH0425885Medicare PIN
OH0305020Medicaid
OH0425884Medicare PIN