Healthcare Provider Details

I. General information

NPI: 1568425668
Provider Name (Legal Business Name): MARION CARROLL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106
US

IV. Provider business mailing address

1020 HOMEWOOD DR
LAKEWOOD OH
44107-1420
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-1000
  • Fax:
Mailing address:
  • Phone: 216-228-6526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35060690
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: