Healthcare Provider Details

I. General information

NPI: 1801886916
Provider Name (Legal Business Name): GREGORY LEE GARDNER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 ORNAC
CONCORD MA
01742-4159
US

IV. Provider business mailing address

2 LILAC LN
CHELMSFORD MA
01824-3427
US

V. Phone/Fax

Practice location:
  • Phone: 978-287-3162
  • Fax: 978-287-3014
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number80837
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number80837
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: