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NPI Code Detail

MEDICARE: DR. JOHN E. GARDELLA MD

MEDICARE: DR. JOHN E. GARDELLA 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
1207RP1001XPulmonary Disease Physician23278NC
2207R00000XInternal Medicine Physician23278NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780653717
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN E. GARDELLA MD
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number : 704-384-5416
Fax Number : 704-384-5992
Provider Business Practice Location Address
First Line : 1500 MATTHEWS TOWNSHIP PKWY
Second Line :
City : MATTHEWS
State : NC
Zip : 28105-4656
Country : US
Telephone Number : 704-384-5416
Fax Number : 704-384-5992
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2006
Last Update Date : 02/13/2013

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