Provider Demographics
NPI:1851599088
Name:CARROLL, MARIANNE (DO)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S OLIVE AVE
Mailing Address - Street 2:# 116
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5501
Mailing Address - Country:US
Mailing Address - Phone:561-968-7546
Mailing Address - Fax:561-968-1143
Practice Address - Street 1:5808 S JOG RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-6511
Practice Address - Country:US
Practice Address - Phone:561-968-7546
Practice Address - Fax:561-968-1143
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9775207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBZ142ZMedicare PIN