Provider Demographics
NPI:1386615755
Name:GARDNER, SANDY LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:SANDY
Middle Name:LYNN
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3219 CLIFTON AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-3027
Mailing Address - Country:US
Mailing Address - Phone:513-559-9411
Mailing Address - Fax:513-559-0419
Practice Address - Street 1:3219 CLIFTON AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-3027
Practice Address - Country:US
Practice Address - Phone:513-559-9411
Practice Address - Fax:513-559-0419
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073496G207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2214811Medicaid
OHGA4039841OtherPTAN
OHGA4039841OtherPTAN
OH4039848Medicare PIN
OHGA4039841Medicare PIN
GA4039849Medicare PIN