Healthcare Provider Details

I. General information

NPI: 1609148378
Provider Name (Legal Business Name): MS. MARY VIRGINIA CARROLL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

977 PERRY HWY
PITTSBURGH PA
15237-2172
US

IV. Provider business mailing address

86 SUMNER AVE
PITTSBURGH PA
15202-3331
US

V. Phone/Fax

Practice location:
  • Phone: 412-899-2185
  • Fax: 412-899-1014
Mailing address:
  • Phone: 412-899-2185
  • Fax: 412-899-1014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number23999
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN665125
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: