Provider Demographics
NPI:1144756370
Name:CLITES, GARRETT (PA-C)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:CLITES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4411 CUMBERLAND HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MEYERSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15552
Mailing Address - Country:US
Mailing Address - Phone:410-255-7900
Mailing Address - Fax:410-522-7300
Practice Address - Street 1:485 RITCHIE HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2918
Practice Address - Country:US
Practice Address - Phone:410-255-7900
Practice Address - Fax:410-255-7300
Is Sole Proprietor?:No
Enumeration Date:2017-05-09
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0006441363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant