Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | OS009150L | PA |
NPI | 1194776047 |
---|---|
Provider Name | Dr. Sean Thomas Carroll |
First Address | Erie, PA 16505-5007 |
Second Address | Erie, PA 16505-5007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 27/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0018263820003 | (05) | PA |
F97188 | (02) | PA |