Individual
KEVIN W CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3623 LATROBE DRIVE, STE 216, CHARLOTTE, NC 28211
(704) 332-1291
(704) 332-5206
Mailing address
PO BOX 221249, CHARLOTTE, NC 28222-1249
(704) 332-1291
(704) 332-5206
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
35085
NC
2085R0202X
Diagnostic Radiology Physician
ME80038
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2381250
AETNA HMO
—
05
—
259310600
—
FL
01
—
35085
NC LICENSE
NC
01
—
35604
BCBS
—
01
—
7444122
AETNA PPO
—
01
—
ME80038
FLORIDA LICENSE
FL
05
—
Q35085
—
SC
Enumeration date
06/02/2006
Last updated
09/12/2020
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