Provider Demographics
NPI:1578572012
Name:GARRETT, PHILIP P (DPM)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:P
Last Name:GARRETT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5249 DUKE ST
Mailing Address - Street 2:# 212
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2907
Mailing Address - Country:US
Mailing Address - Phone:703-370-2313
Mailing Address - Fax:703-370-2490
Practice Address - Street 1:5249 DUKE ST
Practice Address - Street 2:#212
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2907
Practice Address - Country:US
Practice Address - Phone:703-370-2313
Practice Address - Fax:703-370-2490
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103001034213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1295790001Medicare NSC
VAU71562Medicare UPIN
VAG01655Medicare PIN