Provider Demographics
NPI:1578390019
Name:EBERLY, ANDREA CECILIA (MD, MS)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:CECILIA
Last Name:EBERLY
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:CECILIA
Other - Last Name:GRAEBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MS
Mailing Address - Street 1:1 INNISBROOK ROAD
Mailing Address - Street 2:
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558
Mailing Address - Country:US
Mailing Address - Phone:609-240-4340
Mailing Address - Fax:609-333-9444
Practice Address - Street 1:1 INNISBROOK ROAD
Practice Address - Street 2:
Practice Address - City:SKILLMAN
Practice Address - State:NJ
Practice Address - Zip Code:08558
Practice Address - Country:US
Practice Address - Phone:609-240-4340
Practice Address - Fax:609-333-9444
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08194600246Z00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other