Provider Demographics
NPI:1063647246
Name:ANDREW T. GERGELY, M.D. & ASSOCIATES LLC
Entity Type:Organization
Organization Name:ANDREW T. GERGELY, M.D. & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHYLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-286-2833
Mailing Address - Street 1:3175 W WARD RD
Mailing Address - Street 2:200
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-3020
Mailing Address - Country:US
Mailing Address - Phone:410-286-2833
Mailing Address - Fax:
Practice Address - Street 1:3175 W WARD RD
Practice Address - Street 2:200
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-3020
Practice Address - Country:US
Practice Address - Phone:410-286-2833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408850600Medicaid