Healthcare Provider Details

I. General information

NPI: 1235690462
Provider Name (Legal Business Name): LEX JORDAN GARDNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

694 GOOD DR STE 112
LANCASTER PA
17601-2433
US

IV. Provider business mailing address

694 GOOD DR STE 112
LANCASTER PA
17601-2433
US

V. Phone/Fax

Practice location:
  • Phone: 717-397-8177
  • Fax: 717-397-2426
Mailing address:
  • Phone: 717-397-8177
  • Fax: 717-397-2426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMT217832
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD493657
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number58288
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: