Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | ME 102236 | FL |
NPI | 1154312387 |
---|---|
Provider Name | Mary Ann Gardner |
First Address | Celebration, FL 34747-5433 |
Second Address | Celebration, FL 34747-5433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2005 |
Last Update Date | 05/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01Y007499NH01 | ANTHEM BCBS (01) | NH |
30204589 | (05) | NH |
417360099 | MAINECARE (01) | ME |
4583146 | AETNA (01) | NH |
8066149 | CIGNA HEALTHCARE OF NH (01) | NH |
F89273 | (02) | |
P00160736 | RAILROAD MEDICARE (01) | NH |