Provider Demographics
NPI:1285745752
Name:GERTNER, RANDY A (MD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:A
Last Name:GERTNER
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 1:101 PARK HILL DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401
Mailing Address - Country:US
Mailing Address - Phone:540-371-3010
Mailing Address - Fax:540-899-9821
Practice Address - Street 1:101 PARK HILL DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401
Practice Address - Country:US
Practice Address - Phone:540-371-3010
Practice Address - Fax:540-899-9821
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010123545207RN0300X
VA0101235455207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00207769OtherRAILROAD
VA184311OtherANTHEM BCBS
VA010104203Medicaid
VA0007355524OtherAETNA
VA004522F92Medicare PIN
H85016Medicare UPIN