DR. JONATHAN DAVID GARDNER (NPI# 1639490840) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639490840 |
| Entity Type | Individual |
| Full Name | DR. JONATHAN DAVID GARDNER |
| Credential | M.D. |
| Practice Address |
12070 Old Line Ctr Ste 303 Waldorf MD 20602-3535 |
| Mailing Address |
12070 Old Line Ctr Ste 303 Waldorf MD 20602-3535 |
| Practice Telephone | 3016455100 |
| Mailing Telephone | 3016455100 |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2019-08-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
D0088104 | MD | Allopathic & Osteopathic Physicians |
| N | 207RA0001X |
Internal Medicine Specialization: Advanced Heart Failure and Transplant Cardiology |
D0088104 | MD | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 110 Hospital Rd Ste 215, Prince Frederick, MD 206784045 | 3016455100 | |
| 315 Martin Luther King Jr Way, Tacoma, WA 984054234 | 2534031700 | |
| 6565 Fannin St, Houston, TX 770302703 | (713) 790-3311 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790230886 | Jonathan Gardner | Nurse Anesthetist, Certified Registered | 2823 Fresno & R St, Fresno, CA 93721-1324 | 2016-08-18 |
| 1487032603 | Jonathan Gardner | Chiropractor | 2230 Airport Blvd, West Columbia, SC 29170-3173 | 2015-05-07 |
| 1083111926 | Jonathan Quinn Gardner | Student in an Organized Health Care Education/Training Program | 500 S Preston St Rm 305, Louisville, KY 40202-1702 | 2018-04-08 |
| 1154600922 | Jonathan M Gardner | Family Medicine | 935 N 1000 W, Tremonton, UT 84337-9356 | 2011-08-11 |
| 1992904528 | Jonathan Parks Gardner | Anesthesiology | 125 Doughty St, Suite 420, Charleston, SC 29403-5736 | 2007-07-13 |
| 1962511840 | Jonathan Todd Gardner | Specialist | 2775 W Dickman Rd, Suite L, Springfield, MI 49015-4895 | 2006-08-30 |
| 1013926872 | Jonathan Blair Gardner | Dentist | 331 Highway 123, East Carbon, UT 84520-0930 | 2006-08-07 |
| Street Address |
12070 OLD LINE CTR STE 303 |
| City | WALDORF |
| State | MD |
| Zip Code | 20602-3535 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972548584 | Shannon L Gilliam | Physician Assistant | 12070 Old Line Ctr Ste 303, Waldorf, MD 20602-3535 | 2006-06-18 |
| 1437412566 | Awail U Sadiq | Internal Medicine | 12070 Old Line Ctr Ste 303, Waldorf, MD 20602-3535 | 2012-06-22 |
| 1760587596 | Samuel B Itscoitz | Internal Medicine | 12070 Old Line Ctr Ste 303, Waldorf, MD 20602-3535 | 2006-09-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053964957 | Haeyoung Choi | Pharmacist | 25 Smallwood Village Center, Waldorf, MD 20602 | 2019-07-19 |
| 1679137194 | Brighter Days Family Services Inc | Counselor | 11680 Doolittle Dr #111, Waldorf, MD 20602 | 2019-04-30 |
| 1396227039 | Lantern Family Services Inc | Community/Behavioral Health | 11680 Doolittle Dr Ste 111, Waldorf, MD 20602 | 2018-08-29 |
| 1093294910 | Metropolitan Vascular Institute LLC | Internal Medicine | 12070 Old Line Ctr Ste 100, Waldorf, MD 20602 | 2018-08-10 |
| 1174009922 | Dr. Arthur B. Sorkin, D.d.s., LLC | Dentist | 3460 Old Washington Rd., Suite 301-b, Waldorf, MD 20602 | 2018-07-16 |
| 1467945030 | Donna Marie Conley-shaw | Behavior Technician | 16 Pagnell Cir, Waldorf, MD 20602 | 2018-06-08 |
| 1811404296 | Loni Berbaum | Speech-Language Pathologist | 4817 Elmley Pl Apt 315, Waldorf, MD 20602 | 2018-01-06 |
| 1891224853 | Linda E Smith | Social Worker | 605 Pst Office Road, #301, Waldorf, MD 20602 | 2017-06-05 |
| 1104373273 | Love Ngum Che | Pharmacist | 25 Smallwood Village, Waldorf, MD 20602 | 2016-09-07 |
| 1639543341 | Matengy Toure | Pharmacist | 129 St Charles Pkwy, Waldorf, MD 20602 | 2015-11-18 |
| Find all providers in zip 20602 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437412566 | Awail U Sadiq | Internal Medicine | 12070 Old Line Ctr Ste 303, Waldorf, MD 20602-3535 | 2012-06-22 |
| 1265553960 | Jerry Salan | Internal Medicine | 13464 Holly Spring Dr, Waldorf, MD 20601-2329 | 2007-04-02 |
| 1760587596 | Samuel B Itscoitz | Internal Medicine | 12070 Old Line Ctr Ste 303, Waldorf, MD 20602-3535 | 2006-09-14 |
| 1669585113 | Chesapeake&washington Heart Care, PC | Internal Medicine | 12070 Old Line Ctr, Suite 303, Waldorf, MD 20602-2513 | 2006-08-17 |
| 1790702157 | Jeffrey B Trabb | Internal Medicine | 2670 Crain Hwy, Suite 300, Waldorf, MD 20601-2806 | 2006-07-15 |
| 1699714469 | Maryland Healthcare Associates LLC | Internal Medicine | 12070 Old Line Ctr, Suite 100, Waldorf, MD 20602-2513 | 2006-06-06 |
| 1669438933 | Terrance A. Collins | Internal Medicine | 2670 Crain Hwy, Suite 300, Waldorf, MD 20601-2806 | 2006-04-25 |
| 1699746271 | Thomas B Haywood | Internal Medicine | 12070 Old Line Ctr, Suite 303, Waldorf, MD 20602-2513 | 2006-01-31 |
| 1356322598 | Satish Jumani | Internal Medicine | 12070 Old Line Ctr, Suite 202, Waldorf, MD 20602-2513 | 2005-11-07 |
| 1740261924 | Gopalakrishnan Srinivasan | Internal Medicine | 3510 Old Washington Road, Suite 100, Waldorf, MD 20602-3234 | 2005-11-07 |
| Find all providers in WALDORF | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.