Provider Demographics
NPI:1073504452
Name:GARDNER, JAMES H (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4461 STARKEY RD
Mailing Address - Street 2:STE 201
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0622
Mailing Address - Country:US
Mailing Address - Phone:540-345-4946
Mailing Address - Fax:540-982-7164
Practice Address - Street 1:4461 STARKEY RD
Practice Address - Street 2:STE 201
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0622
Practice Address - Country:US
Practice Address - Phone:540-345-4946
Practice Address - Fax:540-982-7164
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2017-04-05
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Provider Licenses
StateLicense IDTaxonomies
VA0101044992207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E37236Medicare UPIN