Basic Information
Provider Information
NPI: 1689683260
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARBER
FirstName: ALAN
MiddleName: CRAIG
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 591
Address2:  
City: BETHEL
State: ME
PostalCode: 042170591
CountryCode: US
TelephoneNumber: 2079912907
FaxNumber:  
Practice Location
Address1: 1 ATWELL RD
Address2:  
City: COOPERSTOWN
State: NY
PostalCode: 133261301
CountryCode: US
TelephoneNumber: 6075473456
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/05/2006
LastUpdateDate: 04/04/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/04/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0200X015171MEY Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine

No ID Information.


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