Provider Demographics
NPI:1679689616
Name:CARROLL, JOHN L (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:L
Last Name:CARROLL
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:955 BELLEFONTE AVE
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-3033
Practice Address - Country:US
Practice Address - Phone:570-748-7714
Practice Address - Fax:570-893-6325
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2020-11-12
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Provider Licenses
StateLicense IDTaxonomies
PAMA052618363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant