Healthcare Provider Details

I. General information

NPI: 1598721078
Provider Name (Legal Business Name): JAMES E CARROLL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 DANFORTH ST
HOOSICK FALLS NY
12090-1226
US

IV. Provider business mailing address

16 DANFORTH ST
HOOSICK FALLS NY
12090-1226
US

V. Phone/Fax

Practice location:
  • Phone: 518-686-5770
  • Fax: 518-686-7751
Mailing address:
  • Phone: 518-686-5770
  • Fax: 518-686-7751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number042-0006978
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number153835-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: