Healthcare Provider Details

I. General information

NPI: 1356348825
Provider Name (Legal Business Name): JAMES LARIMER GARDNER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 N JEFFERSON ST
NEW CASTLE PA
16101-2164
US

IV. Provider business mailing address

804 N JEFFERSON ST
NEW CASTLE PA
16101-2164
US

V. Phone/Fax

Practice location:
  • Phone: 724-652-3616
  • Fax: 724-652-3879
Mailing address:
  • Phone: 724-652-3616
  • Fax: 724-652-3879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD014260E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: