Provider Demographics
NPI:1720125313
Name:CAROL J. GARDNER, DO PC
Entity Type:Organization
Organization Name:CAROL J. GARDNER, DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:802-879-6544
Mailing Address - Street 1:905 ROOSEVELT HWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-4475
Mailing Address - Country:US
Mailing Address - Phone:802-879-6544
Mailing Address - Fax:802-879-0022
Practice Address - Street 1:905 ROOSEVELT HWY
Practice Address - Street 2:SUITE 210
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-4475
Practice Address - Country:US
Practice Address - Phone:802-879-6544
Practice Address - Fax:802-879-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT032-000053207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty