Provider Demographics
NPI:1437341419
Name:RICHARD P GARDNER MD PSC
Entity Type:Organization
Organization Name:RICHARD P GARDNER MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-948-2246
Mailing Address - Street 1:1919 STATE ST STE 240
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-6804
Mailing Address - Country:US
Mailing Address - Phone:812-948-2246
Mailing Address - Fax:812-944-6172
Practice Address - Street 1:1919 STATE ST STE 240
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6804
Practice Address - Country:US
Practice Address - Phone:812-948-2246
Practice Address - Fax:812-944-6172
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHARD P GARDNER MD PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-14
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023879174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN214910AMedicare PIN