Provider Demographics
NPI:1508225947
Name:GHERGHINA, ANDREI P (DO, MS)
Entity Type:Individual
Prefix:DR
First Name:ANDREI
Middle Name:P
Last Name:GHERGHINA
Suffix:
Gender:M
Credentials:DO, MS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10151 ENTERPRISE CTR STE 204
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3761
Mailing Address - Country:US
Mailing Address - Phone:561-405-3000
Mailing Address - Fax:561-459-1444
Practice Address - Street 1:10151 ENTERPRISE CTR STE 204
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3761
Practice Address - Country:US
Practice Address - Phone:561-405-3000
Practice Address - Fax:561-459-1444
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-13
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO4347207N00000X
FLOS14108207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJN916OtherPTAN