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General NPI Number Information
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NPI Number | 1851673420
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Entity Type | Individual
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Provider Name | JOSEPH CHARLES CARROLL IV D.O
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Gender | Male
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Dates
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Enumeration Date | 09/09/2011
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 1500 N RITTER AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-3027
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Country | US
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Telephone | 317-355-1411
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6005 DEPT 196
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City | INDIANAPOLIS
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State | IN
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Zip | 46206-6005
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Country | US
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Telephone | 866-282-7905
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Fax | 800-731-0751
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 02004826A
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License Number State | IN
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