Provider Demographics
NPI:1003840166
Name:GARCIA, JUAN R JR (CCA)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:R
Last Name:GARCIA
Suffix:JR
Gender:M
Credentials:CCA
Other - Prefix:
Other - First Name:GARCIA MEDICAL
Other - Middle Name:
Other - Last Name:ART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:600 N WOLFE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10310 S DOLFIELD RD
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3510
Practice Address - Country:US
Practice Address - Phone:410-356-7839
Practice Address - Fax:410-998-0887
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
229N00000X
MD5271320002229N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes229N00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersAnaplastologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5271320002Medicare NSC