Basic Information
| Provider Information | |||||||||
| NPI: | 1235294489 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARROLL HEALTH GROUP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 900 | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211580900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108481818 | ||||||||
| FaxNumber: | 4108763159 | ||||||||
| Practice Location | |||||||||
| Address1: | 295 STONER AVE | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211575698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108481818 | ||||||||
| FaxNumber: | 4108763156 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 10/01/2015 | ||||||||
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| AuthorizedOfficialLastName: | BLUMBERG | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | EMPLOYEE | ||||||||
| AuthorizedOfficialTelephone: | 4108481818 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1286701 | 01 | AETNA | OTHER | 1544512 | 01 | GATEWAY HEALTH PLAN | OTHER | 357439 | 01 | HEALTH AMERICA | OTHER |