Provider Demographics
NPI:1194776047
Name:CARROLL, SEAN THOMAS (DO)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:THOMAS
Last Name:CARROLL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:380 E BAYFRONT PKWY STE 3
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-2408
Mailing Address - Country:US
Mailing Address - Phone:814-877-9060
Mailing Address - Fax:814-877-9089
Practice Address - Street 1:380 E BAYFRONT PKWY STE 3
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-2408
Practice Address - Country:US
Practice Address - Phone:814-877-9060
Practice Address - Fax:814-877-9089
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009150L207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018263820003Medicaid
PA0018263820003Medicaid
044570KYFMedicare PIN