Provider Demographics
NPI:1952475576
Name:CARROL, ANNE MCDONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:MCDONALD
Last Name:CARROL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3619 PARK EAST DR
Mailing Address - Street 2:SUITE 311
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4330
Mailing Address - Country:US
Mailing Address - Phone:216-831-3494
Mailing Address - Fax:216-831-4595
Practice Address - Street 1:36000 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4625
Practice Address - Country:US
Practice Address - Phone:216-831-3494
Practice Address - Fax:216-831-4595
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.060318207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0938552Medicaid
OH0938552Medicaid
OH0938552Medicaid