Provider Demographics
NPI:1215987417
Name:GANDSAS, ALEJANDRO (MD)
Entity type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:
Last Name:GANDSAS
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:PO BOX 12622
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4017
Mailing Address - Country:US
Mailing Address - Phone:443-481-6573
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2000 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3742
Practice Address - Country:US
Practice Address - Phone:443-481-6699
Practice Address - Fax:443-481-6713
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2013-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD60748208600000X
NJ25MA08709400208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00349038OtherR/R MEDICARE PROVIDER #
MDCC1923OtherR/R MEDICARE GROUP #
V7930014OtherCAREFIRST AAPG SURGICAL HOSPITALISTS
Y7920002OtherBCBS
MD403212800Medicaid
241615Y5ZMedicare PIN
MDP00349038OtherR/R MEDICARE PROVIDER #
MDCC1923OtherR/R MEDICARE GROUP #