Individual
BENJAMIN JOHN GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
8322 BELLONA AVE, SUITE 100, TOWSON, MD 21204-2065
(410) 337-7900
(410) 337-5321
Mailing address
8322 BELLONA AVE, SUITE 100, TOWSON, MD 21204-2065
(410) 337-7900
(410) 337-5321
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
C0005516
MD
363AS0400X
Surgical Physician Assistant
C0005516
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C0005516
PA-C LICENSE
MD
Enumeration date
09/08/2014
Last updated
09/08/2014
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