Provider Demographics
NPI:1457373763
Name:CARROLL, ALICIA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:MARIE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 TATE BLVD SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1465
Mailing Address - Country:US
Mailing Address - Phone:828-267-2660
Mailing Address - Fax:
Practice Address - Street 1:2660 TATE BLVD SE
Practice Address - Street 2:SUITE 200
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1465
Practice Address - Country:US
Practice Address - Phone:828-267-2660
Practice Address - Fax:828-267-2661
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101318174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89130G1Medicaid
NCH48310Medicare UPIN
NC2293675DMedicare ID - Type Unspecified