Individual
TIMOTHY B GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 MEDICAL CENTER DR, LEBANON, NH 03756-1000
(605) 650-5000
Mailing address
1 MEDICAL CENTER DR, LEBANON, NH 03756-1000
(603) 650-5000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
042-0010476
VT
207RG0100X
Gastroenterology Physician
Primary
11794
NH
207RG0100X
Gastroenterology Physician
138343
MT
207RG0100X
Gastroenterology Physician
49986
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1009382
—
VT
05
—
3077317
—
NH
05
—
352155000
—
MN
01
—
P00427363
MEDICARE RAILROAD
MN
Enumeration date
09/21/2005
Last updated
03/19/2024
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