Healthcare Provider Details

I. General information

NPI: 1942617766
Provider Name (Legal Business Name): CARROLL HEALTH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 STONER AVE SUITE 205
WESTMINSTER MD
21157-5698
US

IV. Provider business mailing address

193 STONER AVE SUITE 110
WESTMINSTER MD
21157-5587
US

V. Phone/Fax

Practice location:
  • Phone: 410-876-3380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN KELBLY
Title or Position: CFO
Credential:
Phone: 410-871-6861