Individual
BRONWEN C CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
840 HARRISON AVE, MENINO 1, BOSTON, MA 02118-2905
(617) 414-4991
(617) 414-4999
Mailing address
BMC PROVIDER ENROLLMENT OFFICE, 960 MASSACHUSETTS AVE,.2ND FLOOR, BOSTON, MA 02118
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
237078
MA
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
237078
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110082537A
—
MA
Enumeration date
02/26/2007
Last updated
04/03/2024
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