MEDICARE: MARY ELIZABET 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
1	207R00000X	Internal Medicine Physician	D0028177	MD

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	:	1730153636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABET CARROLL M.D.

Provider Business Mailing Address
First Line	:	4313 CONIFER CT.
Second Line	:
City	:	GLEN ARM
State	:	MD
Zip	:	21057-9124
Country	:	US
Telephone Number	:	410-882-5064
Fax Number	:

Provider Business Practice Location Address
First Line	:	9110 PHILADELPHIA RD.
Second Line	:	STE. 108
City	:	ROSEDALE
State	:	MD
Zip	:	21237-4301
Country	:	US
Telephone Number	:	410-574-3655
Fax Number	:

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	08/14/2008

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