Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | CT034871 | CT |
N | 207ND0900X | Dermatopathologist | CT034871 | CT |
NPI | 1376557199 |
---|---|
Provider Name | Mrs. Carolyn B Carroll |
First Address | Clinton, CT 06413-2058 |
Second Address | Clinton, CT 06413-2058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 11/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001348714 | (05) | CT |
F61552 | (02) |