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General NPI Number Information
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NPI Number | 1235294489
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Entity Type | Organization
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Legal Business Name | CARROLL HEALTH GROUP LLC
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 10/01/2015
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Provider Practice Location Address
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Address Line | 295 STONER AVE
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City | WESTMINSTER
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State | MD
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Zip | 21157-5698
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Country | US
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Telephone | 410-848-1818
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Fax | 410-876-3156
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Provider Business Mailing Address
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Address Line | PO BOX 900
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City | WESTMINSTER
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State | MD
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Zip | 21158-0900
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Country | US
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Telephone | 410-848-1818
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Fax | 410-876-3159
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Authorized Official
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Title or Position | EMPLOYEE
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Name | DAVID BLUMBERG
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Credential | MD
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Telephone | 410-848-1818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number |
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License Number State |
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