Provider Demographics
NPI:1609175892
Name:GARDNER, ROBERT EMIL (MED)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EMIL
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 TULIP POPLAR CT
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3376
Mailing Address - Country:US
Mailing Address - Phone:443-617-7861
Mailing Address - Fax:
Practice Address - Street 1:VA MARYLAND HEALTH CARE SYSTEM
Practice Address - Street 2:RECREATIONAL THERAPY
Practice Address - City:PERRY POINT
Practice Address - State:MD
Practice Address - Zip Code:21902
Practice Address - Country:US
Practice Address - Phone:410-642-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225800000X
N/A225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist