Healthcare Provider Details

I. General information

NPI: 1538132055
Provider Name (Legal Business Name): CHRISTOPHER CARROLL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-9850
  • Fax: 860-545-9800
Mailing address:
  • Phone: 860-545-9850
  • Fax: 860-545-9800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number040267
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: