Provider Demographics
NPI:1215120951
Name:CARROLLTOWNE MEDICAL CENTER P.A.
Entity type:Organization
Organization Name:CARROLLTOWNE MEDICAL CENTER P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:TURGEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-549-2000
Mailing Address - Street 1:1380 PROGRESS WAY
Mailing Address - Street 2:SUITE112
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6464
Mailing Address - Country:US
Mailing Address - Phone:410-549-2000
Mailing Address - Fax:410-549-2103
Practice Address - Street 1:1380 PROGRESS WAY
Practice Address - Street 2:SUITE112
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6464
Practice Address - Country:US
Practice Address - Phone:410-549-2000
Practice Address - Fax:410-549-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0033540207Q00000X
MDH0037356207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========Medicaid
MD=========Medicaid
MD028MMedicare PIN
MDE16560Medicare UPIN