MEDICARE: DR. JOHN S GARRA MD

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	207VG0400X	Gynecology Physician	25MA02158000	NJ

General Provider Information

NPI Number	:	1255318390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN S GARRA MD

Provider Business Mailing Address
First Line	:	500 GROVE ST
Second Line	:	SUITE 100
City	:	HADDON HEIGHTS
State	:	NJ
Zip	:	08035-1702
Country	:	US
Telephone Number	:	856-796-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1055 HADDON AVE
Second Line	:
City	:	COLLINGSWOOD
State	:	NJ
Zip	:	08108-2047
Country	:	US
Telephone Number	:	856-854-4524
Fax Number	:	856-854-8216

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	06/30/2012

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