MEDICARE: DR. PAUL DIMITRE GARST M.D.

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	207R00000X	Internal Medicine Physician	G48697	CA

General Provider Information

NPI Number	:	1770553828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL DIMITRE GARST M.D.

Provider Business Mailing Address
First Line	:	6223 LEE HWY
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22205-2011
Country	:	US
Telephone Number	:	703-532-8988
Fax Number	:	703-532-8999

Provider Business Practice Location Address
First Line	:	MEDICAL DIRECTOR, TRICARE REGIONAL OFFICE NORTH
Second Line	:	1700 N. MOORE ST., SUITE 1200
City	:	ARLINGTON
State	:	VA
Zip	:	22209
Country	:	US
Telephone Number	:	703-588-1831
Fax Number	:	703-696-5216

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	07/08/2007

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