Basic Information
Provider Information
NPI: 1396339750
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CARROLL
FirstName: AARON
MiddleName: MICHAEL
NamePrefix: DR.
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5112 EVELYN BYRD RD
Address2:  
City: RICHMOND
State: VA
PostalCode: 232253022
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1250 E MARSHALL ST
Address2:  
City: RICHMOND
State: VA
PostalCode: 232985023
CountryCode: US
TelephoneNumber: 8048289000
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/25/2021
LastUpdateDate: 02/25/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/25/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X0024181035VAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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