Provider Demographics
NPI:1336144831
Name:GERGELY, ANDREW THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:THOMAS
Last Name:GERGELY
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 1:3175 W WARD RD
Mailing Address - Street 2:200
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-3024
Mailing Address - Country:US
Mailing Address - Phone:410-286-0664
Mailing Address - Fax:140-286-2834
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:20754-3024
Practice Address - Country:US
Practice Address - Phone:410-286-0664
Practice Address - Fax:140-286-2834
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD439722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD145861200Medicaid
MD145861200Medicaid
MD377M526FMedicare PIN