Basic Information
| Provider Information | |||||||||
| NPI: | 1841654829 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARRETT | ||||||||
| FirstName: | TIFFANY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8105 MANSON ST | ||||||||
| Address2: | |||||||||
| City: | LANDOVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207852717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012543683 | ||||||||
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| Practice Location | |||||||||
| Address1: | 765 KENILWORTH TER NE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200191898 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2023888160 | ||||||||
| FaxNumber: | 2025488600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2016 | ||||||||
| LastUpdateDate: | 11/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DO034893 | DC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.