Provider Demographics
NPI:1770775876
Name:G PETER PUSHKAS M D, P C
Entity type:Organization
Organization Name:G PETER PUSHKAS M D, P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:G
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:PUSHKAS
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:301-881-3940
Mailing Address - Street 1:1012 SANDPIPER LN
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-4633
Mailing Address - Country:US
Mailing Address - Phone:301-881-3940
Mailing Address - Fax:301-230-2635
Practice Address - Street 1:1012 SANDPIPER LN
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-4633
Practice Address - Country:US
Practice Address - Phone:301-881-3940
Practice Address - Fax:301-230-2635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2015-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCB94137Medicare UPIN
DC176074Medicare PIN