Provider Demographics
NPI:1225035280
Name:GARDINER, WALTER H (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:H
Last Name:GARDINER
Suffix:
Gender:M
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:PO BOX 1728
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00821-1728
Mailing Address - Country:US
Mailing Address - Phone:340-773-3227
Mailing Address - Fax:340-773-8997
Practice Address - Street 1:5134 SUNDIAL PARK
Practice Address - Street 2:GALLOWS BAY
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4673
Practice Address - Country:US
Practice Address - Phone:340-773-3227
Practice Address - Fax:340-773-8997
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1008170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
0080262Medicare ID - Type Unspecified
B03131Medicare UPIN