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MR. LEE GORDON CARROLL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
6701 N CHARLES ST, TOWSON, MD 21204-6808
(410) 296-4616
(410) 337-5068
Mailing address
110 WEST RD STE 210, TOWSON, MD 21204-2341
(410) 296-4616
(410) 337-5068

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R144380
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
R144380
STATE LICENCE
Enumeration date
07/30/2007
Last updated
10/25/2007
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