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General NPI Number Information
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NPI Number | 1790125409
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Entity Type | Individual
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Provider Name | KEVIN LAWRENCE GARDNER M.D.,PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/26/2013
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Last Update Date | 06/26/2013
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Provider Practice Location Address
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Address Line | NATIONAL INSTITUTES OF HEALTH 37 CONVENT DR. BLDG 37, RM 1042
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City | BETHESDA
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State | MD
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Zip | 20892-0001
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Country | US
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Telephone | 301-496-1055
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Fax |
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Provider Business Mailing Address
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Address Line | NATIONAL INSTITUTES OF HEALTH 37 CONVENT DR. BLDG 37, RM 1042
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City | BETHESDA
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State | MD
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Zip | 20892-0001
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Country | US
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Telephone | 301-496-1055
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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 | 284300000X
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Taxonomy Name | Special Hospital
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License Number | D0041238
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License Number State | MD
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