Provider Demographics
NPI:1154412096
Name:BARRY N GARDINER MD INC
Entity type:Organization
Organization Name:BARRY N GARDINER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:N
Authorized Official - Last Name:GARDINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-275-1210
Mailing Address - Street 1:2301 CAMINO RAMON
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4440
Mailing Address - Country:US
Mailing Address - Phone:925-275-1210
Mailing Address - Fax:925-275-1200
Practice Address - Street 1:2301 CAMINO RAMON
Practice Address - Street 2:SUITE 215
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4440
Practice Address - Country:US
Practice Address - Phone:925-275-1210
Practice Address - Fax:925-275-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG16217208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA39734Medicare UPIN
CAZZZ39222ZMedicare PIN