Provider Demographics
NPI:1902917628
Name:CARROLL, DAWNE MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:DAWNE
Middle Name:MARIA
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12138 CENTRAL AVE STE 953
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1910
Mailing Address - Country:US
Mailing Address - Phone:301-818-1243
Mailing Address - Fax:240-435-2692
Practice Address - Street 1:14408 WOODMORE OAKS CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-1910
Practice Address - Country:US
Practice Address - Phone:301-818-1243
Practice Address - Fax:240-435-2692
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041759207Q00000X
DCMD16892207Q00000X, 282N00000X
MDD0042719207Q00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC032383200Medicaid
MD182901700Medicaid
VA010001331Medicaid
MD523329100Medicaid
DC032383200Medicaid
MD182901700Medicaid