MEDICARE: JAMES A CAROLAN M.D.

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	174400000X	Specialist	A77481	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1316940620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES A CAROLAN M.D.

Provider Business Mailing Address
First Line	:	975 SERENO DR
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94589-2441
Country	:	US
Telephone Number	:	707-651-1042
Fax Number	:

Provider Business Practice Location Address
First Line	:	975 SERENO DR
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94589-2441
Country	:	US
Telephone Number	:	707-651-1042
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	12/13/2021

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