Provider Demographics
NPI:1649251687
Name:GARRETT, ROBIN W (DO)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:W
Last Name:GARRETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 CHEAT RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-5631
Mailing Address - Country:US
Mailing Address - Phone:304-594-2400
Mailing Address - Fax:304-594-2256
Practice Address - Street 1:933 CHEAT RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-5631
Practice Address - Country:US
Practice Address - Phone:304-594-2400
Practice Address - Fax:304-594-2256
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2007082000Medicaid
WV3810002243Medicaid
WV001709238OtherGROUP BLUE SHIELD #
WV001744975OtherINDIVIDUAL BS #
WV001709238OtherGROUP BLUE SHIELD #
WV4118492Medicare PIN