Healthcare Provider Details

I. General information

NPI: 1124120316
Provider Name (Legal Business Name): PEARLINE MCKENZIE-GARNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 JEFFERSON DAVIS HWY NC1, 12TH FL RM 300, ATTN SAIG-TI (MEDICAL OFFICER)
ARLINGTON VA
22202-3926
US

IV. Provider business mailing address

1121 ANNAPOLIS RD # 224
ODENTON MD
21113-1633
US

V. Phone/Fax

Practice location:
  • Phone: 703-601-1190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number0101054882
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: