Basic Information
| Provider Information | |||||||||
| NPI: | 1043476575 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARROLL ENDOCRINOLOGY ASSOCIATES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | JAMES A DICKE MD PA | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 826 WASHINGTON RD | ||||||||
| Address2: | SUITE 121 | ||||||||
| City: | WESTMINSTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211575779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107512510 | ||||||||
| FaxNumber: | 4107512515 | ||||||||
| Practice Location | |||||||||
| Address1: | 826 WASHINGTON RD | ||||||||
| Address2: | SUITE 121 | ||||||||
| City: | WESTMINSTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211575779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107512510 | ||||||||
| FaxNumber: | 4107512515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2008 | ||||||||
| LastUpdateDate: | 10/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | DICKE | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | ALLEN | ||||||||
| AuthorizedOfficialTitleorPosition: | M.D. | ||||||||
| AuthorizedOfficialTelephone: | 4107512510 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CARROLL ENDOCRINOLOGY ASSOCIATES, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.