Provider Demographics
NPI:1356348825
Name:GARDNER, JAMES LARIMER JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LARIMER
Last Name:GARDNER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
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
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014260E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010014600002Medicaid
PAH10507Medicare UPIN
PA0010014600002Medicaid