Healthcare Provider Details

I. General information

NPI: 1710983499
Provider Name (Legal Business Name): STUART ALEXANDER GARDNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 01/26/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 DAVIS ST SUITE A
BLACKSBURG VA
24060-7009
US

IV. Provider business mailing address

825 DAVIS ST SUITE A
BLACKSBURG VA
24060-7009
US

V. Phone/Fax

Practice location:
  • Phone: 540-951-6000
  • Fax: 540-951-9400
Mailing address:
  • Phone: 540-951-6000
  • Fax: 540-951-9400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMD030836E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD030836E
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number0101243628
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: