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General NPI Number Information
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NPI Number | 1124401948
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Entity Type | Individual
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Provider Name | DEVIN CHRISTOPHER CARROLL DPM
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Gender | Male
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 5835 HARBOUR VIEW BLVD STE A
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City | SUFFOLK
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State | VA
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Zip | 23435-2601
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Country | US
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Telephone | 757-384-6617
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Fax | 757-686-3669
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Provider Business Mailing Address
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Address Line | 171 N MAIN ST
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City | SUFFOLK
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State | VA
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Zip | 23434-4507
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Country | US
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Telephone | 757-934-0768
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Fax | 757-925-1901
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0103301236
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License Number State | VA
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