Healthcare Provider Details

I. General information

NPI: 1285977421
Provider Name (Legal Business Name): COURTNEY R GARDNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 07/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 GREECE CENTER DR STE 4
ROCHESTER NY
14612-1358
US

IV. Provider business mailing address

60 GREECE CENTER DR STE 4
ROCHESTER NY
14612-1358
US

V. Phone/Fax

Practice location:
  • Phone: 585-602-0100
  • Fax: 585-453-9240
Mailing address:
  • Phone: 585-602-0100
  • Fax: 585-453-9240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number288246
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number288246
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number288246
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: