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General NPI Number Information
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NPI Number | 1275612459
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Entity Type | Organization
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Legal Business Name | CARROLL INTERNAL MEDICINE ASSOCIATES LLC
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 291 STONER AVE SUITE 203
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City | WESTMINSTER
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State | MD
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Zip | 21157-5647
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Country | US
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Telephone | 410-848-2449
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Fax | 410-848-2798
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Provider Business Mailing Address
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Address Line | 291 STONER AVE STE 203 SUITE 203
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City | WESTMINSTER
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State | MD
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Zip | 21157-5659
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Country | US
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Telephone | 410-848-2449
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Fax | 410-848-2798
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. CHARLOTTE A KEENEY
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Credential |
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Telephone | 410-848-2449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D31660
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License Number State | MD
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