Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 3106 | OH |
NPI | 1619086618 |
---|---|
Provider Name | Dr. Edward Nicholas Carrol |
First Address | Shaker Heights, OH 44122-1964 |
Second Address | Cleveland, OH 44106-1702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |