Individual
MADELINE MAE CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
445 CHARLES H DIMMOCK PKWY STE 100, COLONIAL HEIGHTS, VA 23834-2990
(804) 520-1764
Mailing address
1024 STRATEM CT, VIRGINIA BEACH, VA 23451-5977
(757) 663-1934
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110010031
VA
363AM0700X
Medical Physician Assistant
Primary
0110010031
VA
Other
Enumeration date
05/06/2024
Last updated
07/09/2024
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