Provider Demographics
NPI:1710983499
Name:GARDNER, STUART ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:ALEXANDER
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 DAVIS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7009
Mailing Address - Country:US
Mailing Address - Phone:540-951-6000
Mailing Address - Fax:540-951-9400
Practice Address - Street 1:825 DAVIS ST
Practice Address - Street 2:SUITE A
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7009
Practice Address - Country:US
Practice Address - Phone:540-951-6000
Practice Address - Fax:540-951-9400
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030836E173000000X, 174400000X
VA0101243628207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No173000000XOther Service ProvidersLegal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1710983499Medicaid
PA00100399200001Medicaid
PAGA104116Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
PA00100399200001Medicaid
VA018288S68Medicare PIN