Provider Demographics
NPI:1710955935
Name:GARRETT, MARJORIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:A
Last Name:GARRETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:945 MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-6064
Mailing Address - Country:US
Mailing Address - Phone:860-643-0319
Mailing Address - Fax:860-812-0310
Practice Address - Street 1:945 MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-6064
Practice Address - Country:US
Practice Address - Phone:860-643-0319
Practice Address - Fax:860-812-0310
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038384207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP2097199OtherOXFORD
CT038384OtherCONNECTICARE
CT6256332OtherCIGNA
CT7884165OtherAETNA
CT001383843Medicaid
CTOV9470OtherHEALTHNET
CT010038384CT02OtherANTHEM BLUE CROSS BLUE SH
CT010038384CT02OtherANTHEM BLUE CROSS BLUE SH
CTH09965Medicare UPIN
CTC03868Medicare PIN