MEDICARE: DR. GARY CECCHI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	G47070	CA
2	174400000X	Specialist	G47070	CA
3	207RH0003X	Hematology & Oncology Physician	MD-20418	HI
4	207RH0003X	Hematology & Oncology Physician	MD61048592	WA
5	207RH0003X	Hematology & Oncology Physician	LT21604	ND
6	207RH0003X	Hematology & Oncology Physician	M-15375	ID

General Provider Information

NPI Number	:	1861480857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY CECCHI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 741716
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-1716
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 NE 87TH AVE STE 320
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98664-1965
Country	:	US
Telephone Number	:	360-514-2550
Fax Number	:	360-514-1927

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	11/05/2025

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