Healthcare Provider Details

I. General information

NPI: 1043218035
Provider Name (Legal Business Name): UROLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 S MAIN ST
FALL RIVER MA
02724-2107
US

IV. Provider business mailing address

340 MAIN STREET SUITE 670
WORCESTER MA
01608-1681
US

V. Phone/Fax

Practice location:
  • Phone: 508-678-0004
  • Fax: 508-678-6970
Mailing address:
  • Phone: 508-754-3566
  • Fax: 508-438-6364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN C CARROLL
Title or Position: PRESIDENT
Credential: MD
Phone: 508-678-0004