Provider Demographics
NPI:1831490713
Name:ANDREW M. GELLADY, MD PA
Entity Type:Organization
Organization Name:ANDREW M. GELLADY, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GELLADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:727-848-4878
Mailing Address - Street 1:5323 GRAND BLVD.
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652
Mailing Address - Country:US
Mailing Address - Phone:727-848-4878
Mailing Address - Fax:727-846-7269
Practice Address - Street 1:5323 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4014
Practice Address - Country:US
Practice Address - Phone:727-848-4878
Practice Address - Fax:727-846-7269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 26499208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037944100Medicaid
FL037944100Medicaid