Provider Demographics
NPI:1205887072
Name:JAMES L. GARDNER, M.D., P.C.
Entity type:Organization
Organization Name:JAMES L. GARDNER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR.
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:ULAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-652-3616
Mailing Address - Street 1:804 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-2164
Mailing Address - Country:US
Mailing Address - Phone:724-652-3616
Mailing Address - Fax:724-652-3879
Practice Address - Street 1:804 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-2164
Practice Address - Country:US
Practice Address - Phone:724-652-3616
Practice Address - Fax:724-652-3879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAJA539920Medicare ID - Type Unspecified