Provider Demographics
NPI:1811143464
Name:MARY E CARROLL MD & ASSOCIATES PA
Entity type:Organization
Organization Name:MARY E CARROLL MD & ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-574-3655
Mailing Address - Street 1:9110 PHILADELPHIA RD
Mailing Address - Street 2:STE 108
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4301
Mailing Address - Country:US
Mailing Address - Phone:410-574-8440
Mailing Address - Fax:410-574-8072
Practice Address - Street 1:9110 PHILADELPHIA RD
Practice Address - Street 2:STE 108
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-4301
Practice Address - Country:US
Practice Address - Phone:410-574-8440
Practice Address - Fax:410-574-8072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD131710Medicare PIN