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General NPI Number Information
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NPI Number | 1912312893
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Entity Type | Organization
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Legal Business Name | CARROLL HEALTH GROUP, LLC
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 12/15/2014
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Provider Practice Location Address
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Address Line | 1 VILLAGE SQ
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City | WESTMINSTER
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State | MD
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Zip | 21157-6145
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Country | US
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Telephone | 410-871-7110
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Fax |
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Provider Business Mailing Address
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Address Line | 193 STONER AVE SUITE 110
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City | WESTMINSTER
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State | MD
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Zip | 21157-5587
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | KEVIN KELBLY
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Credential |
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Telephone | 410-871-6861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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