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NPI Code Detail

MEDICARE: CHARLES LOYD CARROLL DO

MEDICARE: CHARLES LOYD CARROLL DO
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
1202C00000XIndependent Medical Examiner Physician02001626AIN
2207Q00000XFamily Medicine Physician02001626AIN
3207P00000XEmergency Medicine Physician02001626AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000198187OTHERINBC/BS #
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3080174096OTHERINRAILROAD
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114927373
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES LOYD CARROLL DO
Provider Business Mailing Address
First Line : 4778 S SCATTERFIELD RD
Second Line :
City : ANDERSON
State : IN
Zip : 46013-2908
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4778 S SCATTERFIELD RD
Second Line :
City : ANDERSON
State : IN
Zip : 46013-2908
Country : US
Telephone Number : 765-646-6331
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2005
Last Update Date : 04/14/2023

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Directions to “ CHARLES LOYD CARROLL DO” Practice Location

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