Provider Demographics
NPI:1942288287
Name:GARDELLA, LYNN ENGLISH (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ENGLISH
Last Name:GARDELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:ELLEN
Other - Last Name:ENGLISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 2500
Mailing Address - Street 2:WESTERN STATE HOSPITAL
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24402-2500
Mailing Address - Country:US
Mailing Address - Phone:540-332-8000
Mailing Address - Fax:540-332-8385
Practice Address - Street 1:103 VALLEY CENTER DRIVE
Practice Address - Street 2:WESTERN STATE HOSPITAL
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401
Practice Address - Country:US
Practice Address - Phone:540-332-8000
Practice Address - Fax:540-332-8385
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045231207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA110070601OtherRAILROAD MEDICARE
E88511Medicare UPIN
VA110004306Medicare PIN