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General NPI Number Information
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NPI Number | 1629029749
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Entity Type | Individual
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Provider Name | EDMUND THOMAS CARROLL III D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 12100 BLACK SWAN DRIVE SUITE 201
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City | LEWES
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State | DE
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Zip | 19958-4988
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Country | US
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Telephone | 302-644-3311
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Fax | 302-644-3300
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Provider Business Mailing Address
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Address Line | 211 EXECUTIVE DR STE 11
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City | NEWARK
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State | DE
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Zip | 19702-3358
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Country | US
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Telephone | 302-451-6913
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Fax | 302-368-7756
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | C20007511
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License Number State | DE
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