=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245484880
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARROLL NEUROSURGICAL ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2008
-----------------------------------------------------
Last Update Date | 11/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 226A WASHINGTON HEIGHTS MED CTR WASHINGTON ROAD
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21157-5633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-848-0362
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 226A WASHINGTON HEIGHTS MED CTR WASHINGTON ROAD
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21157-5633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-848-0362
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE ADMINISTRATOR
-----------------------------------------------------
Name | MRS. CAROLYN JEAN REINKE
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 410-386-9095
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | D17126
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------