=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194512319
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARROLL HEALTH GROUP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2025
-----------------------------------------------------
Last Update Date | 04/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 193 STONER AVE STE 220
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21157-6881
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-871-7080
-----------------------------------------------------
Fax | 410-871-6534
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 45962
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21297-5962
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-469-4269
-----------------------------------------------------
Fax | 410-469-4160
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO CHC
-----------------------------------------------------
Name | MICHAEL MYERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-871-6114
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------