Healthcare Provider Details

I. General information

NPI: 1285745752
Provider Name (Legal Business Name): RANDY A GERTNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PARK HILL DR
FREDERICKSBURG VA
22401
US

IV. Provider business mailing address

101 PARK HILL DR
FREDERICKSBURG VA
22401
US

V. Phone/Fax

Practice location:
  • Phone: 540-371-3010
  • Fax: 540-899-9821
Mailing address:
  • Phone: 540-371-3010
  • Fax: 540-899-9821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number010123545
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0101235455
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: