Provider Demographics
NPI:1528165420
Name:KAROL, JONATHAN W (DO)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:W
Last Name:KAROL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BRAMHALL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3134
Mailing Address - Country:US
Mailing Address - Phone:207-662-7010
Mailing Address - Fax:207-662-7025
Practice Address - Street 1:335 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2362
Practice Address - Country:US
Practice Address - Phone:207-662-8515
Practice Address - Fax:207-662-8133
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME903207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E69124Medicare UPIN
MEMM3039Medicare PIN
MEMM303901Medicare PIN