1811025653 NPI number — GARRETT SURGICAL GROUP, P.A.

Table of content: (NPI 1811025653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811025653 NPI number — GARRETT SURGICAL GROUP, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARRETT SURGICAL GROUP, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811025653
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
255 N 4TH ST STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21550-1340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-334-8282
Provider Business Mailing Address Fax Number:
301-334-8468

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 N 4TH ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21550-1340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-334-8282
Provider Business Practice Location Address Fax Number:
301-334-8468
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WALCH
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-334-8282

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  D47925 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: S3300000 . This is a "BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 022248500 . This is a "MEDICAID" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 205900200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 413716 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 330396 . This is a "TRIGON BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1395892 . This is a "MWA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: H814GA . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 260066 . This is a "BLACK LUNG" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0499579 . This is a "WELFARE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: H814GA . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com