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General NPI Number Information
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NPI Number | 1891814018
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Entity Type | Organization
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Legal Business Name | MARSHALL KEITH GARDNER, D.O., P.C.
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 15 ANTHONY DR
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City | RICHBORO
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State | PA
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Zip | 18954-1328
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Country | US
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Telephone | 215-969-3013
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Fax | 215-676-2522
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Provider Business Mailing Address
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Address Line | 15 ANTHONY DR
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City | RICHBORO
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State | PA
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Zip | 18954-1328
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Country | US
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Telephone | 215-969-3013
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Fax | 215-676-2522
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | FRAN GARDNER
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Credential |
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Telephone | 215-969-3013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS003214L
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License Number State | PA
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