MEDICARE: JENNIFER L CARROLL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	35079394	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306849401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L CARROLL M.D.

Provider Business Mailing Address
First Line	:	9318 STATE ROUTE 14
Second Line	:	3RD FLOOR
City	:	STREETSBORO
State	:	OH
Zip	:	44241
Country	:	US
Telephone Number	:	330-626-2710
Fax Number	:	330-626-5978

Provider Business Practice Location Address
First Line	:	9318 STATE ROUTE 14
Second Line	:	3RD FLOOR
City	:	STREETSBORO
State	:	OH
Zip	:	44241-5224
Country	:	US
Telephone Number	:	330-626-2710
Fax Number	:	330-626-5978

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	12/18/2020

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