Provider Demographics
NPI:1760478663
Name:GARDNER, HOWARD M (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:M
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 1:354 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1754
Mailing Address - Country:US
Mailing Address - Phone:978-687-2321
Mailing Address - Fax:978-685-7265
Practice Address - Street 1:354 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1754
Practice Address - Country:US
Practice Address - Phone:978-687-2321
Practice Address - Fax:978-685-7265
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27515207T00000X
NH4657207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH00000072Medicaid
MA23586OtherFCHP
MA05-00256OtherEVERCARE
MA06-00005OtherUHC
MA2092301Medicaid
MA714454OtherTHP
MAD13191OtherBCBSMA
MA0003738OtherNHP
MA4475150OtherAETNA
MA0099421-001OtherCIGNA
MA12179OtherHPHC
MA05-00256OtherEVERCARE
MAD13191Medicare ID - Type UnspecifiedMEDICARE
MA06-00005OtherUHC