Provider Demographics
NPI:1306404868
Name:GADDIS, ANDREW LEACH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:LEACH
Last Name:GADDIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:143 E NORTH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-5918
Mailing Address - Country:US
Mailing Address - Phone:516-314-7697
Mailing Address - Fax:
Practice Address - Street 1:5200 EASTERN AVE FL 3
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2753
Practice Address - Country:US
Practice Address - Phone:410-550-0526
Practice Address - Fax:410-550-1094
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD978092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry