MEDICARE: DR. WALTER H GARDINER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170100000X	Ph.D. Medical Genetics	1008	VI

General Provider Information

NPI Number	:	1225035280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER H GARDINER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1728
Second Line	:
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00821-1728
Country	:	US
Telephone Number	:	340-773-3227
Fax Number	:	340-773-8997

Provider Business Practice Location Address
First Line	:	5134 SUNDIAL PARK
Second Line	:	GALLOWS BAY
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820-4673
Country	:	US
Telephone Number	:	340-773-3227
Fax Number	:	340-773-8997

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	01/29/2008

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