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Individual

PETER GARDNER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
92 JORDAN LN, STAMFORD, CT 06903-3914
(203) 940-2995
(203) 547-6194
Mailing address
92 JORDAN LANE, STAMFORD, CT 06903
(203) 940-2995
(203) 547-6194

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
024317
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
010027907CT01
BC/BS ID #
01
020183
HEALTHNET ID #
01
024317
CT CARE ID #
01
061246885
UNITED HEATLHCARE ID #
01
25013
OXFORD ID #
01
4125202
AETNA
Enumeration date
09/29/2005
Last updated
03/21/2016
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