Individual
ANDREA GAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2051 WEST ST, ANNAPOLIS, MD 21401-3006
(443) 603-0758
Mailing address
5000 COX RD, GLEN ALLEN, VA 23060-9263
(804) 968-5700
(804) 217-7991
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2180
WV
207P00000X
Emergency Medicine Physician
65060
WI
207Q00000X
Family Medicine Physician
2180
WV
207Q00000X
Family Medicine Physician
D36761
MD
207Q00000X
Family Medicine Physician
Primary
H0060072
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1923578
AETNA CAPITATED
MD
01
—
2200372
MAMSI- SPECIALIST
MD
01
—
224132
JHHC- PROVIDER NUMBER
MD
01
—
2717215
UNITED HEALTHCARE
MD
05
—
415385500
—
MD
01
—
7387630
AETNA- FEE FOR SERVICE
MD
01
—
7605-0099
CAREFIRST
MD
01
—
8200372
MAMSI- PRIMARY CARE
MD
01
—
893418-05
CAREFIRST MD RENDERING
MD
01
—
P00875673
RAILROAD MEDICARE
MD
01
—
P18266
CAREFIRST MPOS
MD
Enumeration date
08/25/2006
Last updated
03/21/2019
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