Provider Demographics
NPI:1982693909
Name:CARROLL, NANCY E (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:E
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 MCKNIGHT RD
Mailing Address - Street 2:STE 123
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-3414
Mailing Address - Country:US
Mailing Address - Phone:412-367-1188
Mailing Address - Fax:412-367-1966
Practice Address - Street 1:4725 MCKNIGHT RD
Practice Address - Street 2:STE 123
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-3414
Practice Address - Country:US
Practice Address - Phone:412-367-1188
Practice Address - Fax:412-367-1966
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023163E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01930980Medicaid
624428OtherBS
PA01930980Medicaid
028826Medicare ID - Type Unspecified
CJ7109Medicare ID - Type UnspecifiedRR