Provider Demographics
NPI:1720187487
Name:O'CARROLL, CHRISTOPHER P (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:P
Last Name:O'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 1:3900 W COAST HWY
Mailing Address - Street 2:SUITE 330
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4091
Mailing Address - Country:US
Mailing Address - Phone:949-759-8001
Mailing Address - Fax:949-760-3671
Practice Address - Street 1:3900 W COAST HWY
Practice Address - Street 2:SUITE 330
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4091
Practice Address - Country:US
Practice Address - Phone:949-759-8001
Practice Address - Fax:949-759-1410
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA386932084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA28699Medicaid
CAA28699Medicare ID - Type UnspecifiedMEDICARE
CAA28699Medicare UPIN