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Individual
CARROLL ISBURG
Active
Individual
CARROLL ISBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
1088
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6700190
—
SD
Enumeration date
08/02/2005
Last updated
10/11/2007
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