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NPI Code Detail

MEDICARE: MARK CARROLL MD

MEDICARE: MARK CARROLL MD
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
1207P00000XEmergency Medicine Physician23336SC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00125463OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073510954
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK CARROLL MD
Provider Business Mailing Address
First Line : 4615 OLEANDER DR
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29577-5741
Country : US
Telephone Number : 843-497-5929
Fax Number : 843-497-9940
Provider Business Practice Location Address
First Line : 2829 E HIGHWAY 76
Second Line :
City : MULLINS
State : SC
Zip : 29574-6035
Country : US
Telephone Number : 843-497-5929
Fax Number : 843-497-9940
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 01/17/2008

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