Provider Demographics
NPI:1861456527
Name:GARRETT, JEFFREY S (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:GARRETT
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 1:1728 BEECHWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1714
Mailing Address - Country:US
Mailing Address - Phone:412-212-3112
Mailing Address - Fax:575-205-0488
Practice Address - Street 1:5750 CENTRE AVE STE 395
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3729
Practice Address - Country:US
Practice Address - Phone:412-212-3112
Practice Address - Fax:575-205-0488
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041758E207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012190530002Medicaid
PA0012190530002Medicaid
WV0085822000Medicaid
PA187352YHIGMedicare PIN
PA0012190530002Medicaid
PAP00222580Medicare PIN
WV0085822000Medicaid