Healthcare Provider Details

I. General information

NPI: 1306849401
Provider Name (Legal Business Name): JENNIFER L CARROLL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9318 STATE ROUTE 14 3RD FLOOR
STREETSBORO OH
44241-5224
US

IV. Provider business mailing address

9318 STATE ROUTE 14 3RD FLOOR
STREETSBORO OH
44241
US

V. Phone/Fax

Practice location:
  • Phone: 330-626-2710
  • Fax: 330-626-5978
Mailing address:
  • Phone: 330-626-2710
  • Fax: 330-626-5978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35079394
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: