Provider Demographics
NPI:1891701736
Name:SITENGA, GARRET LAMENDOLA (MD)
Entity Type:Individual
Prefix:
First Name:GARRET
Middle Name:LAMENDOLA
Last Name:SITENGA
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 1:4381 E HILL RD
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-8203
Mailing Address - Country:US
Mailing Address - Phone:907-235-2358
Mailing Address - Fax:907-235-9777
Practice Address - Street 1:4381 E HILL RD
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-8203
Practice Address - Country:US
Practice Address - Phone:907-235-2358
Practice Address - Fax:907-235-9777
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKMD3811207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD3811Medicaid
AK180034315OtherRR MEDICARE
AKD08608864OtherDME/SUBMITTER ID
AK6105980001Medicare NSC
AKK150029Medicare PIN
AK180034315OtherRR MEDICARE