Healthcare Provider Details

I. General information

NPI: 1326041989
Provider Name (Legal Business Name): TIMOTHY JOEL GARRAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 CORNELIA ST STE 101
PLATTSBURGH NY
12901-2318
US

IV. Provider business mailing address

210 CORNELIA ST STE 101
PLATTSBURGH NY
12901-2318
US

V. Phone/Fax

Practice location:
  • Phone: 518-562-7990
  • Fax: 518-562-7991
Mailing address:
  • Phone: 518-562-7990
  • Fax: 518-562-7991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number1641201
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: