Provider Demographics
NPI:1831804632
Name:GERBER, ARCHELIUS
Entity type:Individual
Prefix:
First Name:ARCHELIUS
Middle Name:
Last Name:GERBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7830 HANOVER PKWY APT 102
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2601
Mailing Address - Country:US
Mailing Address - Phone:240-667-6055
Mailing Address - Fax:
Practice Address - Street 1:7830 HANOVER PKWY APT 102
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2601
Practice Address - Country:US
Practice Address - Phone:240-667-6055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11846-162-250-0676246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD11846-162-250-0676Medicaid