Provider Demographics
NPI:1295716298
Name:ANDREWS, GREGORY A (MD ABPM ABFM FASAM)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:MD ABPM ABFM FASAM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4402 PEACH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1375
Mailing Address - Country:US
Mailing Address - Phone:814-616-0075
Mailing Address - Fax:814-281-5956
Practice Address - Street 1:ANDREWS INSTITUTE FOR ADDICTION TREATMENT, LLC
Practice Address - Street 2:4402 PEACH ST., SUITE 4
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509
Practice Address - Country:US
Practice Address - Phone:814-616-0075
Practice Address - Fax:814-281-5956
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425417207QA0401X, 2083A0300X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000543279OtherANTHEM, BCBS
IN200239810Medicaid
PAG43995Medicare UPIN
IN151020KKKMedicare PIN