=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174939011
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARROLL HEALTH GROUP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2014
-----------------------------------------------------
Last Update Date | 03/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4231 N WOODS TRL STE 100
-----------------------------------------------------
City | HAMPSTEAD
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21074-3204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-374-0675
-----------------------------------------------------
Fax | 410-374-3847
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4231 N WOODS TRL STE 100
-----------------------------------------------------
City | HAMPSTEAD
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21074-3204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-239-2662
-----------------------------------------------------
Fax | 410-374-3847
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF FINANCE
-----------------------------------------------------
Name | MICHAEL MYERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-871-6114
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------