Healthcare Provider Details

I. General information

NPI: 1831116649
Provider Name (Legal Business Name): BRIAN STEPHEN GARRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 LAKE MINNEOLA SHRS
CLERMONT FL
34711-9400
US

IV. Provider business mailing address

8916 TONBRIDGE TER
ADELPHI MD
20783-2052
US

V. Phone/Fax

Practice location:
  • Phone: 301-332-9876
  • Fax: 301-796-9925
Mailing address:
  • Phone: 301-434-0506
  • Fax: 301-796-9925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberME134315
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number042-0009657
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: