Provider Demographics
NPI:1740375443
Name:GARDNER, ROBERT W (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3150 ROGERS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4195
Mailing Address - Country:US
Mailing Address - Phone:919-504-4000
Mailing Address - Fax:984-235-1250
Practice Address - Street 1:3150 ROGERS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4195
Practice Address - Country:US
Practice Address - Phone:919-504-4000
Practice Address - Fax:984-235-1250
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200201082207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE813Medicare PIN
NC2019206Medicare PIN
NC2019206BMedicare PIN
NC0103715OtherUHC
NCC6887OtherMEDCOST
NC2019206Medicare PIN
NC803473OtherPARTNERS
NC89134FFMedicaid