MEDICARE: GARRETT ANESTHESIA AND PAIN MANAGEMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0000X	Pain Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932934353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARRETT ANESTHESIA AND PAIN MANAGEMENT

Provider Business Mailing Address
First Line	:	957 NATIONAL HWY STE 3
Second Line	:
City	:	LAVALE
State	:	MD
Zip	:	21502-7356
Country	:	US
Telephone Number	:	240-362-7128
Fax Number	:	240-362-7129

Provider Business Practice Location Address
First Line	:	4 S BROADWAY
Second Line	:
City	:	FROSTBURG
State	:	MD
Zip	:	21532-1708
Country	:	US
Telephone Number	:	301-689-3138
Fax Number	:	301-689-9561

Authorized Official
Title or Position	:	OWNER
Name	:	MELVIN R GONZAGA
Credential	:	MD
Telephone Number	:	240-362-7128

Provider Enumeration Date	:	09/05/2024
Last Update Date	:	09/05/2024

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Directions to “GARRETT ANESTHESIA AND PAIN MANAGEMENT ” Practice Location

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