Provider Demographics
NPI:1669436309
Name:GARVERT, TERRY A (MD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:A
Last Name:GARVERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:A
Other - Last Name:BRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11800 SUNRISE VALLEY DR
Mailing Address - Street 2:SUITE 700
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-5300
Mailing Address - Country:US
Mailing Address - Phone:703-834-1473
Mailing Address - Fax:703-318-7463
Practice Address - Street 1:11800 SUNRISE VALLEY DR
Practice Address - Street 2:SUITE 700
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-5300
Practice Address - Country:US
Practice Address - Phone:703-834-1473
Practice Address - Fax:703-318-7463
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238906207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1669436309Medicaid
VA018205F32Medicare ID - Type Unspecified
I44523Medicare UPIN