Provider Demographics
NPI:1932217262
Name:GANCAYCO, THEODORE A (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:A
Last Name:GANCAYCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 MEDICAL PKWY STE 320
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7901
Mailing Address - Country:US
Mailing Address - Phone:410-571-8733
Mailing Address - Fax:
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:SUITE 011
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017
Practice Address - Country:US
Practice Address - Phone:202-529-5200
Practice Address - Fax:202-269-3462
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0038919207W00000X
DCMD20277207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD060221300Medicaid
F50317Medicare UPIN