Provider Information for 1407364375
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CHRISTIAN CARROLL
Sex: Male
NPI: 1407364375
Last Updated: 2018-01-13
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1407364375 | ||||||||
| Enumeration Date | 2018-01-13 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 108 CHAPS WAY NORTH WALES, PA 19454-4236 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 108 CHAPS WAY NORTH WALES, PA 19454-4236 United States Phone: 202-709-8461 | Fax: | ||||||||
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