Provider Demographics
NPI:1104972926
Name:GARDINER, SARA KATHRYN (MD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:KATHRYN
Last Name:GARDINER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 NW 20TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1671
Mailing Address - Country:US
Mailing Address - Phone:503-869-0428
Mailing Address - Fax:503-227-8058
Practice Address - Street 1:1318 NW 20TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1671
Practice Address - Country:US
Practice Address - Phone:503-869-0428
Practice Address - Fax:503-227-8058
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD255272084P0800X
CAA666142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry