Provider Demographics
NPI:1558359653
Name:GARAZO, HENRY FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:FERNANDO
Last Name:GARAZO
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 1:1140 CONRAD CT
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5905
Mailing Address - Country:US
Mailing Address - Phone:301-791-1800
Mailing Address - Fax:301-791-9253
Practice Address - Street 1:1140 CONRAD CT
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5905
Practice Address - Country:US
Practice Address - Phone:301-791-1800
Practice Address - Fax:301-791-9253
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052231208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA057037QHMOtherMEDICARE
PA057037QHMOtherMEDICARE
G50450Medicare UPIN