Provider Demographics
NPI:1740312636
Name:GEORGE CARROLL MD PA
Entity type:Organization
Organization Name:GEORGE CARROLL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-894-9959
Mailing Address - Street 1:100 EAST SYBELIA AVENUE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4750
Mailing Address - Country:US
Mailing Address - Phone:407-894-9959
Mailing Address - Fax:
Practice Address - Street 1:100 EAST SYBELIA AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4750
Practice Address - Country:US
Practice Address - Phone:407-894-9959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48111207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty