Provider Demographics
NPI:1699738252
Name:CARROLL, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9422
Mailing Address - Country:US
Mailing Address - Phone:207-282-9080
Mailing Address - Fax:207-282-9180
Practice Address - Street 1:9 HEALTHCARE DRIVE
Practice Address - Street 2:SUITE 204
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-3742
Practice Address - Country:US
Practice Address - Phone:207-284-2630
Practice Address - Fax:207-284-2631
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014332208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1041112OtherAETNA
620050901OtherCIGNA
ME269230099Medicaid
MEG33685OtherHARVARD PILGRIM
ME030300OtherANTHEM
ME269230099Medicaid
ME1041112OtherAETNA
G33685Medicare UPIN