Healthcare Provider Details

I. General information

NPI: 1417986712
Provider Name (Legal Business Name): IVAN H GARCIA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 LORD BALTIMORE DR. SUITE 300
BALTIMORE MD
21244-2566
US

IV. Provider business mailing address

2925 LORD BALTIMORE DR. SUITE 300
BALTIMORE MD
21244-2566
US

V. Phone/Fax

Practice location:
  • Phone: 410-277-3937
  • Fax: 410-281-9388
Mailing address:
  • Phone: 410-277-3937
  • Fax: 410-281-9388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateMD

VIII. Authorized Official

Name: MR. EDWARD JOHN WASLOSKI
Title or Position: FOUNDING MEMBER
Credential: O.D.
Phone: 410-281-2656