Provider Demographics
NPI:1750579074
Name:MORNINGSTAR & CARROLL PA
Entity type:Organization
Organization Name:MORNINGSTAR & CARROLL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-447-6156
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:EMMITSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21727-0309
Mailing Address - Country:US
Mailing Address - Phone:301-447-6155
Mailing Address - Fax:301-447-3289
Practice Address - Street 1:310 S SETON AVE
Practice Address - Street 2:
Practice Address - City:EMMITSBURG
Practice Address - State:MD
Practice Address - Zip Code:21727-9227
Practice Address - Country:US
Practice Address - Phone:301-447-6155
Practice Address - Fax:301-447-3289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2010-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0018705207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD977201400Medicaid
MD977201400Medicaid
MDS094Medicare PIN