Provider Demographics
NPI:1659619682
Name:CARROLL, DOUGLAS GORDON III (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:GORDON
Last Name:CARROLL
Suffix:III
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 1:1117 GREENSPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3611
Mailing Address - Country:US
Mailing Address - Phone:410-823-2640
Mailing Address - Fax:
Practice Address - Street 1:1117 GREENSPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-3611
Practice Address - Country:US
Practice Address - Phone:410-823-2640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD26510207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine