Healthcare Provider Details

I. General information

NPI: 1518412782
Provider Name (Legal Business Name): GARRETT ANESTHESIA & PAIN MGMT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

957 NATIONAL HWY FL 1
LAVALE MD
21502-7356
US

IV. Provider business mailing address

957 NATIONAL HWY FL 1
LAVALE MD
21502-7356
US

V. Phone/Fax

Practice location:
  • Phone: 240-362-7718
  • Fax: 240-362-7731
Mailing address:
  • Phone: 240-362-7718
  • Fax: 240-362-7731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: AUSTIN WHITE
Title or Position: PRESIDENT
Credential:
Phone: 240-362-7718