MEDICARE: PAUL ANDRE GARRETT PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	C02360	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063431880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL ANDRE GARRETT PA-C

Provider Business Mailing Address
First Line	:	5103 MARLIN CT
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20603-4248
Country	:	US
Telephone Number	:	301-466-7376
Fax Number	:	240-518-8881

Provider Business Practice Location Address
First Line	:	6357 OXON HILL RD
Second Line	:
City	:	OXON HILL
State	:	MD
Zip	:	20745-2214
Country	:	US
Telephone Number	:	301-839-2700
Fax Number	:	301-839-1354

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/29/2019

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