Healthcare Provider Details

I. General information

NPI: 1861480857
Provider Name (Legal Business Name): GARY CECCHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE STE 320
VANCOUVER WA
98664-1965
US

IV. Provider business mailing address

PO BOX 741716
ATLANTA GA
30374-1716
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-2550
  • Fax: 360-514-1927
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG47070
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD61048592
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberLT21604
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberM-15375
License Number StateID
# 5
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD-20418
License Number StateHI
# 6
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberG47070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: