MEDICARE: DR. DAVID LANCE 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	2084P0800X	Psychiatry Physician	11742	DC

General Provider Information

NPI Number	:	1942480678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID LANCE GARDNER MD

Provider Business Mailing Address
First Line	:	2015 R ST NW
Second Line	:	SUITE 101
City	:	WASHINGTON
State	:	DC
Zip	:	20009-1075
Country	:	US
Telephone Number	:	202-265-9399
Fax Number	:	202-232-2650

Provider Business Practice Location Address
First Line	:	2015 R ST NW
Second Line	:	SUITE 101
City	:	WASHINGTON
State	:	DC
Zip	:	20009-1075
Country	:	US
Telephone Number	:	202-265-9399
Fax Number	:	202-232-2650

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

Provider Enumeration Date	:	11/09/2007
Last Update Date	:	11/09/2007

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