Provider Demographics
NPI:1396770665
Name:GARRETT, ALGIN BAYLOR (MD)
Entity type:Individual
Prefix:DR
First Name:ALGIN
Middle Name:BAYLOR
Last Name:GARRETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:5201 HICKORY PARK DR STE A
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-2623
Practice Address - Country:US
Practice Address - Phone:804-262-6060
Practice Address - Fax:804-262-6422
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031834207N00000X, 207ND0101X
PAMD464996207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5940290Medicaid
VA541581185OtherEIN
VAD71236Medicare UPIN
VA070000022Medicare PIN