Provider Demographics
NPI:1154057032
Name:GARAN, MARK THOMAS (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:THOMAS
Last Name:GARAN
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 FINCH AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2626
Mailing Address - Country:US
Mailing Address - Phone:304-224-8456
Mailing Address - Fax:
Practice Address - Street 1:243 THREE SPRINGS DR STE 5A
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3839
Practice Address - Country:US
Practice Address - Phone:740-792-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV112744363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner