Provider Demographics
NPI:1447383062
Name:STUART A. GARDNER MC, PC
Entity Type:Organization
Organization Name:STUART A. GARDNER MC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-652-5100
Mailing Address - Street 1:401 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-2238
Mailing Address - Country:US
Mailing Address - Phone:724-652-5100
Mailing Address - Fax:724-652-5890
Practice Address - Street 1:401 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-2238
Practice Address - Country:US
Practice Address - Phone:724-652-5100
Practice Address - Fax:724-652-5890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030836E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00100399200001Medicaid
C3018Medicare UPIN
PA00100399200001Medicaid