Healthcare Provider Details

I. General information

NPI: 1285428078
Provider Name (Legal Business Name): CHRISTOPHER ANDREAS CARROLL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD
NEWARK DE
19718-2200
US

IV. Provider business mailing address

2206 S CLARION ST
PHILADELPHIA PA
19148-2918
US

V. Phone/Fax

Practice location:
  • Phone: 704-582-2339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number153782
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: