Provider Demographics
NPI:1013993385
Name:CARROLL, ELIZABETH J (DO)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
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 1:471 PEQUEA AVE
Mailing Address - Street 2:P.O. BOX460
Mailing Address - City:HONEY BROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19344
Mailing Address - Country:US
Mailing Address - Phone:610-273-2429
Mailing Address - Fax:610-273-3798
Practice Address - Street 1:471 PEQUEA AVE
Practice Address - Street 2:
Practice Address - City:HONEY BROOK
Practice Address - State:PA
Practice Address - Zip Code:19344
Practice Address - Country:US
Practice Address - Phone:610-273-2429
Practice Address - Fax:610-273-3798
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004211L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006823860003Medicaid
PA0006823860003Medicaid
PA095828FBDMedicare ID - Type UnspecifiedMEDICARE NUMBER