Individual
JERAD MICHAEL GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 N ACADEMY AVE, DANVILLE, PA 17822-7101
(570) 271-6338
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
(570) 271-6578
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
E7425
AR
207ZD0900X
Dermatopathology (Pathology) Physician
N5684
TX
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
E7425
AR
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
TMD004672
PA
Other
Enumeration date
12/20/2008
Last updated
05/28/2020
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