Provider Demographics
NPI:1861615510
Name:GIFFORD, GREGORY CARDEN (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:CARDEN
Last Name:GIFFORD
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 1:111 SUNNYBROOK CT.
Mailing Address - Street 2:CENTER FOR HOSPICE AND PALLIATIVE CARE, INC.
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-3437
Mailing Address - Country:US
Mailing Address - Phone:574-243-3100
Mailing Address - Fax:574-243-3134
Practice Address - Street 1:111 SUNNYBROOK CT
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637-3437
Practice Address - Country:US
Practice Address - Phone:574-243-3100
Practice Address - Fax:574-243-3134
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034956A207QH0002X
INO1O34956207P00000X
IN01034956207PH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B48056Medicare UPIN
INB48056Medicare UPIN