Provider Demographics
NPI:1285620401
Name:STAPLES, GARY S (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:S
Last Name:STAPLES
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 1:7503 SURRATTS RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3358
Mailing Address - Country:US
Mailing Address - Phone:301-870-7001
Mailing Address - Fax:301-870-6697
Practice Address - Street 1:7501 SURRATTS RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3362
Practice Address - Country:US
Practice Address - Phone:301-870-7001
Practice Address - Fax:301-870-6697
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2013-03-22
Deactivation Date:2009-09-24
Deactivation Code:
Reactivation Date:2013-03-22
Provider Licenses
StateLicense IDTaxonomies
MDD0018817174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD163622S80Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #