Provider Demographics
NPI:1003885948
Name:GARAVENTE, EILEEN M (MD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:M
Last Name:GARAVENTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 STONER AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157
Mailing Address - Country:US
Mailing Address - Phone:410-876-3355
Mailing Address - Fax:410-848-3647
Practice Address - Street 1:193 STONER AVENUE
Practice Address - Street 2:SUITE 300
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157
Practice Address - Country:US
Practice Address - Phone:410-876-3355
Practice Address - Fax:410-876-3355
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057370207V00000X
PAMD071513L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
30088134OtherAMERIHEALTH MERCY-WMG
MD039157300Medicaid
PA10254307Medicaid
PA30088199OtherAMERIHEALTH MERCY-YH
PA416566OtherUPMC-WMG
30088134OtherAMERIHEALTH MERCY-WMG
H42040Medicare UPIN
MD039157300Medicaid