Provider Demographics
NPI:1477541753
Name:PERIC STEPCIC, GORDANA (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDANA
Middle Name:
Last Name:PERIC STEPCIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10231 OLD OCEAN CITY BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-3566
Mailing Address - Country:US
Mailing Address - Phone:410-641-2220
Mailing Address - Fax:410-629-0348
Practice Address - Street 1:10231 OLD OCEAN CITY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3566
Practice Address - Country:US
Practice Address - Phone:410-641-2220
Practice Address - Fax:410-629-0348
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00567642084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG80974Medicare UPIN
MD995L651EMedicare ID - Type Unspecified