Provider Demographics
NPI:1316918295
Name:GARROW, MARYLU (NP)
Entity type:Individual
Prefix:
First Name:MARYLU
Middle Name:
Last Name:GARROW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-852-0600
Mailing Address - Fax:508-853-7149
Practice Address - Street 1:630 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-852-0600
Practice Address - Fax:508-853-7149
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA130676363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherPRIVATE HEALTHCARE SYSTEM
57607OtherFALLON COMMUNITY HEALTH P
NP0782OtherMEDICARE B
8300304OtherEVERCARE
042472266OtherTHREE RIVERS
AA3452OtherHARVARD PILGRIM HEALTHCAR
NP0782OtherBLUE SHIELD HMO BLUE
NP0782OtherBLUE SHIELD INDEMNITY
042472266OtherTRICARE CHAMPUS
380001263OtherRAILROAD MEDICARE
04247226OtherONE HEALTH PLAN
NP0782OtherBLUE CARE ELECT
380001263OtherRAILROAD MEDICARE
AA3452OtherHARVARD PILGRIM HEALTHCAR