MEDICARE: CARROLL FAMILY MEDICINE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CN 7035	OTHER	MD	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0877346	OTHER	MD	AETNA US HEALTHCARE
2	4508793	OTHER	MD	AETNA MC/PPO/EPO
4	11071	OTHER	MD	PREFERRED HEALTH NETWORK
5	E289	OTHER	MD	BC/BS FED/BLUE CHOICE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	KC91CA	OTHER	MD	BC/BS PAR/PPN/POS
8	MAMSI	OTHER	MD	250778
9	10112104	OTHER	MD	CIGNA

General Provider Information

NPI Number	:	1043240708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARROLL FAMILY MEDICINE, LLC

Provider Business Mailing Address
First Line	:	814 HOUCKSVILLE RD
Second Line	:
City	:	HAMPSTEAD
State	:	MD
Zip	:	21074-1882
Country	:	US
Telephone Number	:	410-239-0406
Fax Number	:	410-239-0407

Provider Business Practice Location Address
First Line	:	814 HOUCKSVILLE RD
Second Line	:
City	:	HAMPSTEAD
State	:	MD
Zip	:	21074-1882
Country	:	US
Telephone Number	:	410-239-0406
Fax Number	:	410-239-0407

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. PETER G UGGOWITZER
Credential	:	M.D.
Telephone Number	:	410-239-0406

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	03/14/2025

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