MEDICARE: DR. JACK L GARDEN MD

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	207RC0000X	Cardiovascular Disease Physician	25MA08143100	NJ
2	207RC0000X	Cardiovascular Disease Physician	MD038681E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356328108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK L GARDEN MD

Provider Business Mailing Address
First Line	:	2422 S BROAD ST
Second Line	:	1ST FLOOR
City	:	PHILA
State	:	PA
Zip	:	19145-4418
Country	:	US
Telephone Number	:	215-389-1748
Fax Number	:	215-389-0604

Provider Business Practice Location Address
First Line	:	2422 S BROAD ST
Second Line	:	1ST FLOOR
City	:	PHILA
State	:	PA
Zip	:	19145-4418
Country	:	US
Telephone Number	:	215-389-1748
Fax Number	:	215-389-0604

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	11/21/2018

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Directions to “ DR. JACK L GARDEN MD” Practice Location

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