Provider Demographics
NPI:1912643255
Name:KNEESE, GARRETT S
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:S
Last Name:KNEESE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 FAIRFAX DR STE 1000
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1782
Mailing Address - Country:US
Mailing Address - Phone:202-741-3570
Mailing Address - Fax:
Practice Address - Street 1:1101 15TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-5002
Practice Address - Country:US
Practice Address - Phone:833-694-9362
Practice Address - Fax:202-379-3570
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
DCMD600004156207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program