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NPI Code Detail

MEDICARE: DR. PAMELA R GARDNER DO

MEDICARE: DR. PAMELA R GARDNER DO
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
1207RC0000XCardiovascular Disease Physician34008055OH

General Provider Information

NPI Number : 1457315004
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAMELA R GARDNER DO
Provider Business Mailing Address
First Line : 1001 BELLEFONTAINE AVE
Second Line :
City : LIMA
State : OH
Zip : 45804-2800
Country : US
Telephone Number : 419-998-4575
Fax Number : 419-998-4586
Provider Business Practice Location Address
First Line : 1003 BELLEFONTAINE AVE STE 200
Second Line :
City : LIMA
State : OH
Zip : 45804-1803
Country : US
Telephone Number : 419-224-5915
Fax Number : 419-224-5918
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2006
Last Update Date : 01/04/2021

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Directions to “ DR. PAMELA R GARDNER DO” Practice Location

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