Individual
BRYAN CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
950 CLAGUE RD BLDG B, WESTLAKE, OH 44145-1533
(216) 844-8200
(440) 250-2022
Mailing address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-1000
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
0101252291
VA
207N00000X
Dermatology Physician
Primary
35.137019
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
-005
TRICARE/CHAMPUS
VA
01
—
10097097
OPTIMA HEALTH
VA
01
—
1609087121
COVENTRY HEALTH NETWORK
VA
05
—
1609087121
—
VA
01
—
473606
ANTHEM BC/BS
VA
05
—
5921028
—
NC
01
—
PAR
CIGNA
VA
Enumeration date
05/25/2007
Last updated
12/30/2020
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