Provider Demographics
NPI:1124120316
Name:MCKENZIE-GARNER, PEARLINE (MD)
Entity type:Individual
Prefix:DR
First Name:PEARLINE
Middle Name:
Last Name:MCKENZIE-GARNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 ANNAPOLIS RD # 224
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1633
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2511 JEFFERSON DAVIS HWY
Practice Address - Street 2:NC1, 12TH FL RM 300, ATTN SAIG-TI (MEDICAL OFFICER)
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-3926
Practice Address - Country:US
Practice Address - Phone:703-601-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010548822083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine