Healthcare Provider Details

I. General information

NPI: 1114100989
Provider Name (Legal Business Name): JOHN T. CARROLL, DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 BOSTON POST RD, UNIT #8
OLD SAYBROOK CT
06475-1554
US

IV. Provider business mailing address

455 BOSTON POST RD, UNIT #8
OLD SAYBROOK CT
06475-1554
US

V. Phone/Fax

Practice location:
  • Phone: 860-510-0502
  • Fax: 860-510-0551
Mailing address:
  • Phone: 860-510-0502
  • Fax: 860-510-0551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN T CARROLL
Title or Position: PRESIDENT
Credential: DPM
Phone: 860-510-0502