Provider Demographics
NPI:1710933890
Name:PECK, GARY L (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:PECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:5454 WISCONSIN AVE
Mailing Address - Street 2:SUITE 1045
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6917
Mailing Address - Country:US
Mailing Address - Phone:301-652-4828
Mailing Address - Fax:301-652-2070
Practice Address - Street 1:5454 WISCONSIN AVE
Practice Address - Street 2:SUITE 1045
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6917
Practice Address - Country:US
Practice Address - Phone:301-652-4828
Practice Address - Fax:301-652-2070
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2022-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DCMD25243207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD118281101Medicaid
DC025751800Medicaid
DC025751800Medicaid
MD118281101Medicaid