1043240708 NPI number — CARROLL FAMILY MEDICINE, LLC

Table of content: (NPI 1043240708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043240708 NPI number — CARROLL FAMILY MEDICINE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARROLL FAMILY MEDICINE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043240708
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
814 HOUCKSVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPSTEAD
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21074-1882
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-239-0406
Provider Business Mailing Address Fax Number:
410-239-0407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
814 HOUCKSVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMPSTEAD
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21074-1882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-239-0406
Provider Business Practice Location Address Fax Number:
410-239-0407
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
UGGOWITZER
Authorized Official First Name:
PETER
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
410-239-0406

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10112104 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4508793 . This is a "AETNA MC/PPO/EPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 11071 . This is a "PREFERRED HEALTH NETWORK" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: E289 . This is a "BC/BS FED/BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0877346 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: KC91CA . This is a "BC/BS PAR/PPN/POS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: MAMSI . This is a "250778" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: CN 7035 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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