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NPI Code Detail

MEDICARE: DR. FRED CARROLL M.D.

MEDICARE: DR. FRED CARROLL 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
1208000000XPediatrics PhysicianMD045103EPA

General Provider Information

NPI Number : 1336427111
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FRED CARROLL M.D.
Provider Business Mailing Address
First Line : 6608 CASTOR AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19149-2120
Country : US
Telephone Number : 215-342-7711
Fax Number :
Provider Business Practice Location Address
First Line : 6608 CASTOR AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19149-2120
Country : US
Telephone Number : 215-342-7711
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2011
Last Update Date : 07/28/2011

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