Provider Demographics
NPI:1063431880
Name:GARRETT, PAUL ANDRE (PA-C)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ANDRE
Last Name:GARRETT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5103 MARLIN CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4248
Mailing Address - Country:US
Mailing Address - Phone:301-466-7376
Mailing Address - Fax:240-518-8881
Practice Address - Street 1:6357 OXON HILL RD
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-2214
Practice Address - Country:US
Practice Address - Phone:301-839-2700
Practice Address - Fax:301-839-1354
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC02360363AM0700X
MDC002360363AS0400X
VA0110001319363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010374782Medicaid
VA010374782Medicaid
P00385087Medicare PIN
Q74924Medicare UPIN