Provider Demographics
NPI:1881676203
Name:GARRETT, ANDREW L (MD, MPH, FAAP, FAEMS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:L
Last Name:GARRETT
Suffix:
Gender:M
Credentials:MD, MPH, FAAP, FAEMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 VIRGINIA AVE NW STE T-100
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1905
Mailing Address - Country:US
Mailing Address - Phone:202-994-0904
Mailing Address - Fax:
Practice Address - Street 1:2600 VIRGINIA AVE NW STE T-100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1905
Practice Address - Country:US
Practice Address - Phone:202-994-0904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-20
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2057656146L00000X
DCMD045818207PE0004X
MA217210208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2014092Medicaid
MAH69732Medicare UPIN
MAGA A35709Medicare ID - Type Unspecified