Provider Demographics
NPI:1053316422
Name:GARDNER, MELINDA MILLER (MD)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:MILLER
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 NEW MEXICO AVE NW
Mailing Address - Street 2:STE 248
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-3610
Mailing Address - Country:US
Mailing Address - Phone:202-244-0706
Mailing Address - Fax:202-686-6278
Practice Address - Street 1:3301 NEW MEXICO AVE NW
Practice Address - Street 2:STE 248
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-3610
Practice Address - Country:US
Practice Address - Phone:202-244-0706
Practice Address - Fax:202-686-6278
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD8400207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0246160001OtherDMERC ADMINISTAR MEDICARE
DC0246160001OtherDMERC ADMINISTAR MEDICARE
DC173318Medicare ID - Type UnspecifiedMEDICARE PROVIDER #