Provider Demographics
NPI:1790125409
Name:GARDNER, KEVIN LAWRENCE (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LAWRENCE
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NATIONAL INSTITUTES OF HEALTH
Mailing Address - Street 2:37 CONVENT DR. BLDG 37, RM 1042
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-0001
Mailing Address - Country:US
Mailing Address - Phone:301-496-1055
Mailing Address - Fax:
Practice Address - Street 1:NATIONAL INSTITUTES OF HEALTH
Practice Address - Street 2:37 CONVENT DR. BLDG 37, RM 1042
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-496-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0041238284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital