Provider Demographics
NPI:1790731107
Name:ANDRECYK, GREGORY PAUL (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:PAUL
Last Name:ANDRECYK
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 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-692-6676
Mailing Address - Fax:603-692-0919
Practice Address - Street 1:85 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-3111
Practice Address - Country:US
Practice Address - Phone:603-692-6676
Practice Address - Fax:603-692-0919
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH11209207Q00000X
MEMD17946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1790731107Medicaid
NH3075576Medicaid
NHG84337Medicare UPIN
ME1790731107Medicaid