Provider Demographics
NPI:1982689550
Name:GARDNER, RICHARD P (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:P
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1919 STATE ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4929
Mailing Address - Country:US
Mailing Address - Phone:812-948-2246
Mailing Address - Fax:812-944-6172
Practice Address - Street 1:1919 STATE ST
Practice Address - Street 2:SUITE 240
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4929
Practice Address - Country:US
Practice Address - Phone:812-948-2246
Practice Address - Fax:812-944-6172
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01023879A207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200333430AMedicaid
IN200333430AMedicaid
INC24720Medicare UPIN
IN214910Medicare PIN