Provider Demographics
NPI:1861503591
Name:CARROLL, BRENDAN THOMAS MORE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:THOMAS MORE
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:330 TAYLOR BLAIR RD
Mailing Address - Street 2:THE NEUROSCIENCE ALLIANCE, LLC
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:43162-9714
Mailing Address - Country:US
Mailing Address - Phone:614-893-0910
Mailing Address - Fax:
Practice Address - Street 1:188 W HEBBLE AVE
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-4960
Practice Address - Country:US
Practice Address - Phone:614-893-0910
Practice Address - Fax:614-879-4169
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH616942084F0202X, 2084P0800X
OH35-0616942084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry