MEDICARE: MOLLIE CLAIRE GARDNER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	363AS0400X	Surgical Physician Assistant
3	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1235918368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLIE CLAIRE GARDNER

Provider Business Mailing Address
First Line	:	1900 LAFAYETTE RD STE A
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-5679
Country	:	US
Telephone Number	:	603-431-1121
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 LAFAYETTE RD STE A
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-5679
Country	:	US
Telephone Number	:	603-431-1121
Fax Number	:

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

Provider Enumeration Date	:	09/27/2023
Last Update Date	:	05/06/2026

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Directions to “ MOLLIE CLAIRE GARDNER ” Practice Location

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