Basic Information
Provider Information | |||||||||
NPI: | 1609829654 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GARMESTANI | ||||||||
FirstName: | ADRIAN | ||||||||
MiddleName: | S | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1340 HAL GREER BLVD | ||||||||
Address2: |   | ||||||||
City: | HUNTINGTON | ||||||||
State: | WV | ||||||||
PostalCode: | 257013804 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3045262200 | ||||||||
FaxNumber: | 3043991507 | ||||||||
Practice Location | |||||||||
Address1: | 1340 HAL GREER BLVD | ||||||||
Address2: |   | ||||||||
City: | HUNTINGTON | ||||||||
State: | WV | ||||||||
PostalCode: | 257013804 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3045262200 | ||||||||
FaxNumber: | 3043991507 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/19/2006 | ||||||||
LastUpdateDate: | 04/13/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/13/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 200300788 | NC | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207P00000X | 21604 | WV | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 64093180 | 05 | KY |   | MEDICAID | P00289180 | 01 | NC | RR MEDICARE | OTHER | 135A9 | 01 | NC | BCBSNC | OTHER | N0078B | 05 | SC |   | MEDICAID | 1609829654 | 05 | WV |   | MEDICAID | Q046958 | 05 | TN |   | MEDICAID | 2507273 | 05 | OH |   | MEDICAID | 89-135A9 | 05 | NC |   | MEDICAID |