Provider Demographics
NPI:1760475909
Name:GASE, ANDREW JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JAMES
Last Name:GASE
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 1:27 ST LAWRENCE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-8313
Mailing Address - Country:US
Mailing Address - Phone:419-447-4214
Mailing Address - Fax:419-447-1905
Practice Address - Street 1:27 ST LAWRENCE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-8313
Practice Address - Country:US
Practice Address - Phone:419-447-4214
Practice Address - Fax:419-447-1905
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2018-12-31
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
OH35-053787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0668684Medicaid
OHA17319Medicare UPIN
OHGA0612433Medicare ID - Type Unspecified