Healthcare Provider Details

I. General information

NPI: 1841654829
Provider Name (Legal Business Name): TIFFANY GARRETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 KENILWORTH TER NE
WASHINGTON DC
20019-1898
US

IV. Provider business mailing address

8105 MANSON ST
LANDOVER MD
20785-2717
US

V. Phone/Fax

Practice location:
  • Phone: 202-388-8160
  • Fax: 202-548-8600
Mailing address:
  • Phone: 301-254-3683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO034893
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: