Provider Demographics
NPI:1386680270
Name:GERGEN, JOHN ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDREW
Last Name:GERGEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:250 PANTOPS MTN RD
Mailing Address - Street 2:#5107
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8701
Mailing Address - Country:US
Mailing Address - Phone:434-972-2406
Mailing Address - Fax:434-791-2644
Practice Address - Street 1:245 HAIRSTON ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4137
Practice Address - Country:US
Practice Address - Phone:434-799-0456
Practice Address - Fax:434-791-2644
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2010-10-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA01012373042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC69587Medicare UPIN
ILG31520Medicare PIN
C69587Medicare UPIN