Provider Demographics
NPI:1154632560
Name:GARY M PIEKAREK MD LLC
Entity Type:Organization
Organization Name:GARY M PIEKAREK MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PIEKAREK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-424-2388
Mailing Address - Street 1:200 KINGS HWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1843
Mailing Address - Country:US
Mailing Address - Phone:302-424-2388
Mailing Address - Fax:302-424-2347
Practice Address - Street 1:200 KINGS HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1843
Practice Address - Country:US
Practice Address - Phone:302-424-2388
Practice Address - Fax:302-424-2347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10003356207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE26693OtherCOVENTRY HEALTHCARE OF DE
DE0000223501Medicaid
DE4197970OtherAETNA
DE0000223501Medicaid
DE26693OtherCOVENTRY HEALTHCARE OF DE
DE26693OtherCOVENTRY HEALTHCARE OF DE
DE4197970OtherAETNA