MEDICARE: PRADEEP GARG 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	D31322	MD

General Provider Information

NPI Number	:	1952376469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRADEEP GARG M.D.

Provider Business Mailing Address
First Line	:	14650 VIBURNUM DR
Second Line	:
City	:	DAYTON
State	:	MD
Zip	:	21036-1246
Country	:	US
Telephone Number	:	410-360-2400
Fax Number	:	410-439-3342

Provider Business Practice Location Address
First Line	:	4304 MOUNTAIN RD
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-4520
Country	:	US
Telephone Number	:	410-360-2400
Fax Number	:	410-439-3342

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

Provider Enumeration Date	:	02/19/2006
Last Update Date	:	12/31/2007

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