Provider Demographics
NPI:1669462073
Name:GARDNER, STEVEN HEDDEN (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:HEDDEN
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MD MPH
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-4900
Mailing Address - Fax:617-228-6306
Practice Address - Street 1:165 CAMBRIDGE ST
Practice Address - Street 2:SUITE 501
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2723
Practice Address - Country:US
Practice Address - Phone:617-726-4900
Practice Address - Fax:617-228-6306
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2014-02-11
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Provider Licenses
StateLicense IDTaxonomies
MA46501207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6164544Medicaid
MA701503OtherTUFTS HEALTH PLAN
MAJ02250OtherBCBS MA
B74203Medicare UPIN
MAJ02250OtherBCBS MA