Provider Demographics
NPI:1952377004
Name:GARTNER, RICHARD CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CHARLES
Last Name:GARTNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:455 SAINT MICHAELS DR
Mailing Address - Street 2:ST. VINCENT HOSPITALIST GROUP
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7601
Mailing Address - Country:US
Mailing Address - Phone:505-989-6130
Mailing Address - Fax:505-820-5408
Practice Address - Street 1:455 SAINT MICHAELS DR
Practice Address - Street 2:ST. VINCENT HOSPITALIST GROUP
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7601
Practice Address - Country:US
Practice Address - Phone:505-989-6130
Practice Address - Fax:505-820-5408
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81827207R00000X
NMMD2011-0698207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAG18940Medicare UPIN