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NPI Code Detail

MEDICARE: DONALD NELSON GARDNER MD

MEDICARE: DONALD NELSON 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
1207Q00000XFamily Medicine Physician30025NC

Other Identifiers

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

General Provider Information

NPI Number : 1659344141
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONALD NELSON GARDNER MD
Provider Business Mailing Address
First Line : PO BOX 602195
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-2195
Country : US
Telephone Number : 919-350-0351
Fax Number : 919-350-7687
Provider Business Practice Location Address
First Line : 4530 FAYETTEVILLE RD
Second Line :
City : RALEIGH
State : NC
Zip : 27603-3614
Country : US
Telephone Number : 919-235-1930
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2006
Last Update Date : 12/22/2021

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