Individual
MARK A GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
510 BUTLER AVE, MARTINSBURG, WV 25405-9990
(304) 263-0811
(800) 817-3807
Mailing address
510 BUTLER AVE, MARTINSBURG, WV 25405-9990
(304) 263-0811
(800) 817-3807
Taxonomy
Speciality
Code
Description
License number
State
213ES0000X
Sports Medicine Podiatrist
Primary
0103000917
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115888
ANTHEM BC/BS
VA
01
—
1215628
CIGNA
VA
01
—
65326
SENTARA
VA
Enumeration date
08/16/2005
Last updated
11/25/2020
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