Organization
JOHN T. CARROLL, DPM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN T CARROLL DPM (PRESIDENT)
(860) 510-0502
Entity
Organization
Contact information
Practice address
455 BOSTON POST RD, UNIT #8, OLD SAYBROOK, CT 06475-1554
(860) 510-0502
(860) 510-0551
Mailing address
455 BOSTON POST RD, UNIT #8, OLD SAYBROOK, CT 06475-1554
(860) 510-0502
(860) 510-0551
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008059379
—
CT
01
—
008063266
MEDICAID DME/MEDICAL SUPPLY DEALER
CT
Enumeration date
12/14/2007
Last updated
01/29/2016
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