1295786184 NPI number — SUSAN GERHARDT ANDREWS M.D.

Table of content: SUSAN GERHARDT ANDREWS M.D. (NPI 1295786184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295786184 NPI number — SUSAN GERHARDT ANDREWS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDREWS
Provider First Name:
SUSAN
Provider Middle Name:
GERHARDT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GERHARDT
Provider Other First Name:
SUSAN
Provider Other Middle Name:
GAIL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295786184
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 62753
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21264-2753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-641-9450
Provider Business Mailing Address Fax Number:
410-641-9515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9733 HEALTHWAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21811-1155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-641-9109
Provider Business Practice Location Address Fax Number:
410-629-1203
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  D0067708 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1013840870001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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