Provider Demographics
NPI:1790753515
Name:GURSKY, ANDREI (MD)
Entity Type:Individual
Prefix:
First Name:ANDREI
Middle Name:
Last Name:GURSKY
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 1:7610 CARROLL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6311
Mailing Address - Country:US
Mailing Address - Phone:301-891-2500
Mailing Address - Fax:301-448-1679
Practice Address - Street 1:7610 CARROLL AVE STE 100
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6311
Practice Address - Country:US
Practice Address - Phone:301-891-2500
Practice Address - Fax:301-448-1679
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100007392083P0011X
VA0101257444208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1790753515Medicaid
MD042495833Medicaid
MOMA3446110Medicare PIN
VAC10441Medicare PIN
I28732Medicare UPIN
VAVVG162AMedicare PIN
MO1790753515Medicaid
MOMA2082248Medicare PIN