Healthcare Provider Details

I. General information

NPI: 1780643098
Provider Name (Legal Business Name): SEAN THOMAS CARROLL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE JARRETT WHITE RD TRIPLER ARMY MEDICAL CENTER, DEPARTMENT OF PEDIATRICS
TRIPLER AMC HI
96859-5000
US

IV. Provider business mailing address

MCHK-PE 1 JARRETT WHITE ROAD
TRIPLER AMC HI
96859-5000
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-4165
  • Fax: 808-433-6227
Mailing address:
  • Phone: 808-433-6212
  • Fax: 808-433-6227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-18880
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number01047208A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: