Provider Demographics
NPI:1619068533
Name:GARDINER, BARRY N (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:N
Last Name:GARDINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2301 CAMINO RAMON
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4440
Mailing Address - Country:US
Mailing Address - Phone:925-275-1210
Mailing Address - Fax:925-275-1200
Practice Address - Street 1:2301 CAMINO RAMON
Practice Address - Street 2:SUITE 215
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4440
Practice Address - Country:US
Practice Address - Phone:925-275-1210
Practice Address - Fax:925-275-1200
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2009-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG16217208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA39734Medicare UPIN
CA00G162170Medicare ID - Type Unspecified