Provider Demographics
NPI:1255540522
Name:GRACIANO P. GANCAYCO MD PA
Entity type:Organization
Organization Name:GRACIANO P. GANCAYCO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GANCAYCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-253-2128
Mailing Address - Street 1:9701 NEW CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-2000
Mailing Address - Country:US
Mailing Address - Phone:301-253-2129
Mailing Address - Fax:301-253-4864
Practice Address - Street 1:9701 NEW CHURCH ST
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-2000
Practice Address - Country:US
Practice Address - Phone:301-253-2129
Practice Address - Fax:301-253-4864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty