Provider Demographics
NPI:1447320353
Name:CARROLLTON MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:CARROLLTON MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MASTRUSERIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-732-9922
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:KY
Mailing Address - Zip Code:41008
Mailing Address - Country:US
Mailing Address - Phone:502-732-9922
Mailing Address - Fax:502-732-9050
Practice Address - Street 1:307 ELEVENTH STREET
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:KY
Practice Address - Zip Code:41008
Practice Address - Country:US
Practice Address - Phone:502-732-9922
Practice Address - Fax:502-732-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty