Provider Demographics
NPI:1710971999
Name:CARROLL, WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
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 1:317 E 34TH ST
Mailing Address - Street 2:8TH FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4974
Mailing Address - Country:US
Mailing Address - Phone:212-263-8400
Mailing Address - Fax:
Practice Address - Street 1:317 E 34TH ST
Practice Address - Street 2:8TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4974
Practice Address - Country:US
Practice Address - Phone:212-263-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2231122080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02198685Medicaid
NY8E2892Medicare ID - Type Unspecified
NY02198685Medicaid