Provider Demographics
NPI:1417771080
Name:GARZA GANGEMI, ADRIAN MAURICIO (MD)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:MAURICIO
Last Name:GARZA GANGEMI
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 1:429 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2202
Mailing Address - Country:US
Mailing Address - Phone:717-761-7244
Mailing Address - Fax:717-312-3094
Practice Address - Street 1:429 N 21ST ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2202
Practice Address - Country:US
Practice Address - Phone:717-761-7244
Practice Address - Fax:717-312-3094
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PALT001041208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology