Provider Demographics
NPI:1952976987
Name:GARRETT, MADISON
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 BOYLSTON ST UNIT 921
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-4461
Mailing Address - Country:US
Mailing Address - Phone:405-343-3898
Mailing Address - Fax:
Practice Address - Street 1:1282 BOYLSTON ST UNIT 921
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-4461
Practice Address - Country:US
Practice Address - Phone:405-343-3898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant