Healthcare Provider Details

I. General information

NPI: 1194512319
Provider Name (Legal Business Name): CARROLL HEALTH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 STONER AVE STE 220
WESTMINSTER MD
21157-6881
US

IV. Provider business mailing address

PO BOX 45962
BALTIMORE MD
21297-5962
US

V. Phone/Fax

Practice location:
  • Phone: 410-871-7080
  • Fax: 410-871-6534
Mailing address:
  • Phone: 410-469-4269
  • Fax: 410-469-4160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL MYERS
Title or Position: CFO CHC
Credential:
Phone: 410-871-6114