Provider Demographics
NPI:1750549499
Name:GARDNER, JUDITH DODRILL (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:DODRILL
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:225 COMMERCIAL ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4613
Mailing Address - Country:US
Mailing Address - Phone:207-780-8148
Mailing Address - Fax:207-780-1121
Practice Address - Street 1:225 COMMERCIAL ST
Practice Address - Street 2:SUITE 403
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4613
Practice Address - Country:US
Practice Address - Phone:207-780-8148
Practice Address - Fax:207-780-1121
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0134202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry