Individual
CHARLES WILLIAM GARDNER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4401 FORD AVE, SUITE 250, ALEXANDRIA, VA 22302-1473
(703) 647-4962
(703) 379-5380
Mailing address
4401 FORD AVE, SUITE 250, ALEXANDRIA, VA 22302-1473
(703) 647-4962
(703) 379-5380
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101033882
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00126329
RAILROAD MEDICARE
—
Enumeration date
11/07/2006
Last updated
07/07/2010
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