Basic Information
| Provider Information | |||||||||
| NPI: | 1578561932 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCARROLL | ||||||||
| FirstName: | RAYMOND | ||||||||
| MiddleName: | EUGENE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2775 SCHOENERSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180177307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108618080 | ||||||||
| FaxNumber: | 6108070366 | ||||||||
| Practice Location | |||||||||
| Address1: | 2775 SCHOENERSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180177307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108618080 | ||||||||
| FaxNumber: | 6108070366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2005 | ||||||||
| LastUpdateDate: | 07/01/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | SC003854L | PA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 0397447000 | 01 | AMERIHEALTH | OTHER | 2170558 | 01 | MAMSI | OTHER | 1987178 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 7657041 | 01 | CIGNA HEALTHCARE | OTHER | 821134 | 01 | FIRST PRIORITY HEALTH | OTHER | 0397447000 | 01 | KEYSTONE HEALTH EAST | OTHER | 0397447000 | 01 | INDEPENDENCE BLUE CROSS | OTHER | P867062 | 01 | OXFORD HEALTH PLANS | OTHER | 480024412 | 01 | MEDICARE RAILROAD | OTHER | 951456 | 01 | HIGHMARK BLUE SHIELD | OTHER | 01212101 | 01 | KEYSTONE HEALTH CENTRAL | OTHER | 328789 | 01 | HEALTHAMERICA/HEALTHASSUR | OTHER | 53645 | 01 | GEISINGER HEALTH PLAN | OTHER | 0016637230001 | 05 | PA | MEDICAID | 01212101 | 01 | CAPITAL BLUE CROSS | OTHER | 2010102 | 01 | UNITED HEALTHCARE | OTHER | 2511166 | 01 | AETNA PPO | OTHER |