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General NPI Number Information
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NPI Number | 1134113020
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Entity Type | Individual
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Provider Name | CLAIRE ELAINE GARDAM NP
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Gender | Female
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Dates
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Enumeration Date | 09/07/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 16 3RD ST STE C
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City | MALONE
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State | NY
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Zip | 12953-1305
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Country | US
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Telephone | 518-483-1015
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Fax | 518-483-0430
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Provider Business Mailing Address
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Address Line | 19 MAPLE ST
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City | CANTON
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State | NY
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Zip | 13617-1338
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Country | US
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Telephone | 315-386-3482
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | F3600271
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License Number State | NY
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