Provider Demographics
NPI:1003874934
Name:MORIN, GARRISON VASILE (MD)
Entity Type:Individual
Prefix:DR
First Name:GARRISON
Middle Name:VASILE
Last Name:MORIN
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 1:158 FRONT ROYAL PIKE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-4346
Mailing Address - Country:US
Mailing Address - Phone:540-313-8976
Mailing Address - Fax:
Practice Address - Street 1:158 FRONT ROYAL PIKE
Practice Address - Street 2:SUITE 108
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-4346
Practice Address - Country:US
Practice Address - Phone:540-313-8976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237343207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I27534Medicare UPIN
WVM04155201Medicare ID - Type Unspecified
WV3810001886Medicaid