Provider Demographics
NPI:1700952355
Name:GARLOCK, PRISCILLA HELEN (MD)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:HELEN
Last Name:GARLOCK
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 1:435 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-1971
Mailing Address - Country:US
Mailing Address - Phone:315-866-5576
Mailing Address - Fax:315-866-5928
Practice Address - Street 1:435 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-1971
Practice Address - Country:US
Practice Address - Phone:315-866-5576
Practice Address - Fax:315-866-5928
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127665207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00622899Medicaid
NY00622899Medicaid
B81729Medicare UPIN