Healthcare Provider Details

I. General information

NPI: 1578572012
Provider Name (Legal Business Name): PHILIP P. GARRETT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5249 DUKE ST #212
ALEXANDRIA VA
22304-2907
US

IV. Provider business mailing address

5249 DUKE ST # 212
ALEXANDRIA VA
22304-2907
US

V. Phone/Fax

Practice location:
  • Phone: 703-370-2313
  • Fax: 703-370-2490
Mailing address:
  • Phone: 703-370-2313
  • Fax: 703-370-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103001034
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: