Provider Demographics
NPI:1831116649
Name:GARRA, BRIAN STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:STEPHEN
Last Name:GARRA
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 1:8916 TONBRIDGE TER
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-2052
Mailing Address - Country:US
Mailing Address - Phone:301-434-0506
Mailing Address - Fax:301-796-9925
Practice Address - Street 1:10810 LAKE MINNEOLA SHRS
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-9400
Practice Address - Country:US
Practice Address - Phone:301-332-9876
Practice Address - Fax:301-796-9925
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1343152085B0100X
VT042-00096572085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTE69219Medicare UPIN
VTGAVN1752Medicare ID - Type Unspecified
VTOVN1752Medicaid