| Dr Ellis Benjamin Gardner, MD FAAP | |
|
18 Roberts Rd, Canaan, NH 03741-7644 | |
| (603) 934-1464 | |
| Not Available |
| Full Name | Dr Ellis Benjamin Gardner |
|---|---|
| Gender | Male |
| Speciality | Pediatric Medicine |
| Experience | 30 Years |
| Location | 18 Roberts Rd, Canaan, New Hampshire |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932130630 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 10330 (New Hampshire) | Primary |
| 208000000X | Pediatrics | 10330 (New Hampshire) | Secondary |
| 208000000X | Pediatrics | 037734 (Connecticut) | Secondary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Lake Sunapee Home Care & Hospice | New london, NH | Home health agency |
| Alice Peck Day Memorial Hospital | Lebanon, NH | Hospital |
| Mary Hitchcock Memorial Hospital | Lebanon, NH | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Healthfirst Family Care Center Inc | 4183688211 | 24 |
| Entity Name | Healthfirst Family Care Center Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1134180367 PECOS PAC ID: 4183688211 Enrollment ID: O20041117000908 |
| Entity Name | Mascoma Community Healthcare Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1497298087 PECOS PAC ID: 2466736525 Enrollment ID: O20170309000707 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Ellis Benjamin Gardner, MD FAAP 43 Caleb Dyer Ln, Mascoma Community Healthcare, Inc., Enfield, NH 03748-3551 Ph: (802) 673-5340 | Dr Ellis Benjamin Gardner, MD FAAP 18 Roberts Rd, Canaan, NH 03741-7644 Ph: (603) 934-1464 |
Frederick Keyser Wiese, M.D. Internal Medicine Medicare: Medicare Enrolled Practice Location: 18 Roberts Road, Canaan, NH 03741 Phone: 603-523-4343 Fax: 603-523-4502 |