Provider Demographics
NPI:1811025653
Name:GARRETT SURGICAL GROUP, P.A.
Entity Type:Organization
Organization Name:GARRETT SURGICAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-334-8282
Mailing Address - Street 1:255 N 4TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-1340
Mailing Address - Country:US
Mailing Address - Phone:301-334-8282
Mailing Address - Fax:301-334-8468
Practice Address - Street 1:255 N 4TH ST STE 2
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1340
Practice Address - Country:US
Practice Address - Phone:301-334-8282
Practice Address - Fax:301-334-8468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD47925261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS3300000OtherBLUE CHOICE
DC022248500OtherMEDICAID
MD205900200Medicaid
PA413716OtherBCBS
MD330396OtherTRIGON BCBS
MD1395892OtherMWA
MDH814GAOtherBCBS
MD260066OtherBLACK LUNG
DC0499579OtherWELFARE
MDH814GAOtherCAREFIRST BCBS
MD260066OtherBLACK LUNG