Basic Information
| Provider Information | |||||||||
| NPI: | 1215987417 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GANDSAS | ||||||||
| FirstName: | ALEJANDRO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12622 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434816573 | ||||||||
| FaxNumber: | 4434816515 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 MEDICAL PKWY | ||||||||
| Address2: | |||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214013742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434816699 | ||||||||
| FaxNumber: | 4434816713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 12/08/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | D60748 | MD | Y | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 25MA08709400 | NJ | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | P00349038 | 01 | MD | R/R MEDICARE PROVIDER # | OTHER | CC1923 | 01 | MD | R/R MEDICARE GROUP # | OTHER | V7930014 | 01 | CAREFIRST AAPG SURGICAL HOSPITALISTS | OTHER | Y7920002 | 01 | BCBS | OTHER | 403212800 | 05 | MD | MEDICAID |