Healthcare Provider Details

I. General information

NPI: 1669389664
Provider Name (Legal Business Name): CARSON CROY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 DUKE DR STE 202
MASON OH
45040-9010
US

IV. Provider business mailing address

8343 CARDNIA CT
LIBERTY TOWNSHIP OH
45044-8353
US

V. Phone/Fax

Practice location:
  • Phone: 937-759-0545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: