Basic Information
Provider Information
NPI: 1003017286
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GASKI
FirstName: GREG
MiddleName: E
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 37174
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212973174
CountryCode: US
TelephoneNumber: 5714235699
FaxNumber: 5714235698
Practice Location
Address1: 8501 ARLINGTON BLVD STE 200
Address2:  
City: FAIRFAX
State: VA
PostalCode: 220314625
CountryCode: US
TelephoneNumber: 7039706464
FaxNumber: 7039706465
Other Information
ProviderEnumerationDate: 05/29/2007
LastUpdateDate: 10/20/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/20/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X0101268243VAY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 
207XX0801X01072242AINN Allopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
207XX0801XME 112059FLN Allopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma

ID Information
IDTypeStateIssuerDescription
010126824301VAVA BOARD OF MEDICINEOTHER
20115707005IN MEDICAID


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