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General NPI Number Information
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NPI Number | 1114927373
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Entity Type | Individual
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Provider Name | CHARLES LOYD CARROLL DO
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Gender | Male
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 04/14/2023
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Provider Practice Location Address
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Address Line | 4778 S SCATTERFIELD RD
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City | ANDERSON
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State | IN
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Zip | 46013-2908
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Country | US
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Telephone | 765-646-6331
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Fax |
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Provider Business Mailing Address
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Address Line | 4778 S SCATTERFIELD RD
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City | ANDERSON
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State | IN
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Zip | 46013-2908
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202C00000X
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Taxonomy Name | Independent Medical Examiner Physician
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License Number | 02001626A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 02001626A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 02001626A
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License Number State | IN
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