Healthcare Provider Details

I. General information

NPI: 1538823125
Provider Name (Legal Business Name): ANDREW MICHAEL GRADONE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 05/10/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 BESTGATE RD
ANNAPOLIS MD
21401-3648
US

IV. Provider business mailing address

2927 SHADOWBROOK CT
ELLICOTT CITY MD
21042-7628
US

V. Phone/Fax

Practice location:
  • Phone: 855-906-1966
  • Fax: 443-782-2342
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number07472
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number07472
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: