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General NPI Number Information
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NPI Number | 1437562618
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Entity Type | Individual
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Provider Name | KELLY J GARDNER MD
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Gender | Female
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Dates
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Enumeration Date | 06/05/2014
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | MASSACHUSETTS GENERAL HOSPITAL 55 FRUIT ST.
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City | BOSTON
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State | MA
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Zip | 02114
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Country | US
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Telephone | 617-726-2687
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Fax |
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Provider Business Mailing Address
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Address Line | MASSACHUSETTS GENERAL HOSPITAL 275 CAMBRIDGE ST, 5TH FLOOR
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City | BOSTON
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State | MA
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Zip | 02114
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Country | US
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Telephone | 617-726-8707
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 269950
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2080S0012X
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Taxonomy Name | Pediatric Sleep Medicine Physician
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License Number | 269950
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 269950
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number | 269950
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License Number State | MA
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