Provider Demographics
NPI:1326585076
Name:ANDREW T. GERGELY, M.D.,L.C.C.
Entity Type:Organization
Organization Name:ANDREW T. GERGELY, M.D.,L.C.C.
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:410-286-0664
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:410-286-0664
Mailing Address - Fax:410-286-2834
Practice Address - Street 1:137 MITCHELLS CHANCE RD
Practice Address - Street 2:260
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2787
Practice Address - Country:US
Practice Address - Phone:410-956-5300
Practice Address - Fax:410-956-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0630101YP2500X
MDLC1239101YP2500X
MDLC6770101YP2500X
MD099271041C0700X
MD039141041C0700X
MD123031041C0700X
MDD439722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty