Provider Demographics
NPI:1023247061
Name:GARDNER, KIMBERLY RUTH (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:RUTH
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:RUTH
Other - Last Name:HANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:17503 NASSAU COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-6283
Mailing Address - Country:US
Mailing Address - Phone:302-645-7919
Mailing Address - Fax:
Practice Address - Street 1:17503 NASSAU COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-6283
Practice Address - Country:US
Practice Address - Phone:302-645-7919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTBD2085R0202X
390200000X
DEC1-00112462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty