Provider Demographics
NPI:1528039054
Name:GARDNER, JAMES MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MATTHEW
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 N 28TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-5311
Mailing Address - Country:US
Mailing Address - Phone:804-521-0050
Mailing Address - Fax:833-973-3890
Practice Address - Street 1:1510 N 28TH ST STE 101
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-5311
Practice Address - Country:US
Practice Address - Phone:804-521-0050
Practice Address - Fax:833-973-3890
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049730207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1528039054Medicaid
VA1528039054Medicaid
G12573Medicare UPIN
VA00W671M02Medicare ID - Type Unspecified