MEDICARE: DR. BETH C. GARDNER 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	207RG0100X	Gastroenterology Physician	25MA05624700	NJ
2	207RG0100X	Gastroenterology Physician	MD034274E	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457334369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETH C. GARDNER MD

Provider Business Mailing Address
First Line	:	525 JAMESTOWN ST
Second Line	:	SUITE 101
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-1751
Country	:	US
Telephone Number	:	215-463-1483
Fax Number	:	215-483-9185

Provider Business Practice Location Address
First Line	:	525 JAMESTOWN ST
Second Line	:	SUITE 101
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-1751
Country	:	US
Telephone Number	:	215-463-1483
Fax Number	:	215-483-9185

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	02/09/2017

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Directions to “ DR. BETH C. GARDNER MD” Practice Location

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