MEDICARE: DR. KEEBA GARDNER

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	103TC0700X	Clinical Psychologist	07681	MD

General Provider Information

NPI Number	:	1932056801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEEBA GARDNER

Provider Business Mailing Address
First Line	:	703 WASHINGTON AVE
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21204-3927
Country	:	US
Telephone Number	:	240-454-5538
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111B S GOVERNORS AVE STE 26881
Second Line	:
City	:	DOVER
State	:	DE
Zip	:	19904-6903
Country	:	US
Telephone Number	:	240-454-5538
Fax Number	:

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

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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