MEDICARE: MARY ANN GARDNER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	ME 102236	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00160736	OTHER	NH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8066149	OTHER	NH	CIGNA HEALTHCARE OF NH
3	417360099	OTHER	ME	MAINECARE
4	01Y007499NH01	OTHER	NH	ANTHEM BCBS
5	4583146	OTHER	NH	AETNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154312387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANN GARDNER M.D.

Provider Business Mailing Address
First Line	:	410 CELEBRATION PL
Second Line	:	STE 300
City	:	CELEBRATION
State	:	FL
Zip	:	34747-5433
Country	:	US
Telephone Number	:	321-939-3300
Fax Number	:	321-939-3303

Provider Business Practice Location Address
First Line	:	410 CELEBRATION PL
Second Line	:	STE 300
City	:	CELEBRATION
State	:	FL
Zip	:	34747-5433
Country	:	US
Telephone Number	:	321-939-3300
Fax Number	:	321-939-3303

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2005
Last Update Date	:	01/05/2010

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Directions to “ MARY ANN GARDNER M.D.” Practice Location

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