Provider Demographics
NPI:1407901812
Name:KENNETH R GAARDER MD PA
Entity Type:Organization
Organization Name:KENNETH R GAARDER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:GAARDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-656-0554
Mailing Address - Street 1:4221 OAKRIDGE LANE
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6058
Mailing Address - Country:US
Mailing Address - Phone:301-656-0554
Mailing Address - Fax:301-656-0554
Practice Address - Street 1:4221 OAKRIDGE LANE
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6058
Practice Address - Country:US
Practice Address - Phone:301-656-0554
Practice Address - Fax:301-656-0554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD18292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B93395Medicare UPIN
105093Medicare ID - Type Unspecified