Provider Demographics
NPI:1568778629
Name:GARRIOTT, CHARLES PHILLIP (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PHILLIP
Last Name:GARRIOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14787-1104
Mailing Address - Country:US
Mailing Address - Phone:716-793-2200
Mailing Address - Fax:
Practice Address - Street 1:189 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NY
Practice Address - Zip Code:14787-1104
Practice Address - Country:US
Practice Address - Phone:716-793-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014862207P00000X
OK5168207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine