Healthcare Provider Details

I. General information

NPI: 1538135678
Provider Name (Legal Business Name): RYAN FRANCIS CARROLL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S UNION AVE
ALLIANCE OH
44601-4355
US

IV. Provider business mailing address

2600 SIXTH ST SW
CANTON OH
44710-1702
US

V. Phone/Fax

Practice location:
  • Phone: 330-596-6500
  • Fax:
Mailing address:
  • Phone: 330-477-9720
  • Fax: 330-458-4600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50001541
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: