{
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"FirstLineMailingAddress": "10451 MILL RUN CIR STE 400",
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"MailingAddressFaxNumber": "410-363-3715",
"FirstLinePracticeLocationAddress": "3104 LORD BALTIMORE DR STE 103",
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"PracticeLocationAddressCityName": "WINDSOR MILL",
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"PracticeLocationAddressTelephoneNumber": "443-893-3928",
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"EnumerationDate": "12/18/2025",
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"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CARROLL",
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"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}