Provider Demographics
NPI:1962573279
Name:CARROLL, REGINA MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:MARTIN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1020 SOUTHHILL DR
Mailing Address - Street 2:SUITE 380
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8629
Mailing Address - Country:US
Mailing Address - Phone:919-360-0517
Mailing Address - Fax:919-678-0014
Practice Address - Street 1:1020 SOUTHHILL DR
Practice Address - Street 2:SUITE 380
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8629
Practice Address - Country:US
Practice Address - Phone:919-360-0517
Practice Address - Fax:919-678-0014
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCO2883Medicare UPIN
NC2282143Medicare ID - Type UnspecifiedPERFORMING PROVIDER NUMBE