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General NPI Number Information
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NPI Number | 1154057032
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Entity Type | Individual
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Provider Name | MARK THOMAS GARAN AGACNP-BC
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Gender | Male
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Dates
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Enumeration Date | 07/25/2022
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Last Update Date | 07/25/2022
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Provider Practice Location Address
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Address Line | 243 THREE SPRINGS DR STE 5A
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City | WEIRTON
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State | WV
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Zip | 26062-3839
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Country | US
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Telephone | 740-792-4220
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Fax |
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Provider Business Mailing Address
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Address Line | 68 FINCH AVE
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City | WHEELING
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State | WV
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Zip | 26003-2626
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Country | US
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Telephone | 304-224-8456
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 112744
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License Number State | WV
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