Garrett Anesthesia and Pain Management
Organization Active NPI Pain Medicine Physician · Lavale, MD
NPI 1073608253 · NPPES record last updated Sep 4, 2018
Key facts
- NPI
- 1073608253
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pain Medicine Physician 208VP0000X
- License
- D222148 (MD)
- Legal business name
- GARRETT ANESTHESIA AND PAIN MANAGEMENT
- Practice address
- 957 National Hwy
Lavale, MD 21502 - Phone
- (240) 362-7128
- Fax
- (240) 362-7129
- NPI assigned
- Oct 4, 2006
- Organization subpart
- No
Authorized official
- Name
- Melvin R Gonzaga, MD
- Title
- Owner
- Phone
- (240) 362-7128
Other NPIs on the same Medicare enrollment 1
Practitioners 5
-
Eliette Yadira Bouie, PA-C
-
Melvin R Gonzaga, MD
-
Shabbar Hussain, M.D.
-
Daisy Amadi Muga, PA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031216000880 | MD | Part B Supplier - Clinic/Group Practice | 2466359500 |
Receives reassigned benefits from 5 practitioners 1 other NPI on this enrollment Practice locations: Hagerstown, MD; Lavale, MD; Oakland, MD |
| O20200522002141 | MD | DME Supplier - Physician - Interventional Pain Management | 2466359500 | Practice locations: Cumberland, MD |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pain Medicine Physician |
208VP0000X | D222148 | MD | Yes |
Addresses
Primary practice location
957 National Hwy
Lavale, MD 21502
Mailing address
957 National Hwy
Lavale, MD 21502-7356
Phone (240) 362-7128
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 961521100 | Medicaid | MD |
Other names
- Gonzaga Interventional Pain Management
Other providers in Lavale, MD
- Wendy Foote
- Fort Ashby Business Associates, Inc
- Erin Samantha Frum
- Brian James Fuente
- Garrett Anesthesia & Pain MGMT
- Garrett Anesthesia and Pain Management
- Garrett Anesthesia and Pain Management
- General Hearing Aid Centers, Inc.
- Lauren Marie Gianni
- Mary L Glanville
All providers in Lavale, MD · Pain Medicine Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 4, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.