1245211788 NPI number — MASON C GASPER DO

Table of content: MASON C GASPER DO (NPI 1245211788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245211788 NPI number — MASON C GASPER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GASPER
Provider First Name:
MASON
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245211788
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 RESERVOIR AVE STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANSTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02910-4453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-714-0222
Provider Business Mailing Address Fax Number:
401-714-0220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 RESERVOIR AVE STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRANSTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02910-4453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-714-0222
Provider Business Practice Location Address Fax Number:
401-714-0220
Provider Enumeration Date:
11/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  223324 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: DO00611 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7238673 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: A3870402 . This is a "MEDICARE PTAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "TRICARE CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7058831 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 468304 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 87317 . This is a "HEALTHY START" identifier . This identifiers is of the category "OTHER".
  • Identifier: 92597 . This is a "FALLON COMMUNITY HEALTH P" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2102242 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 007058833 . This is a "MEDICARE PTAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: J29259 . This is a "BLUE CARE ELECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2102242 . This is a "MEDICAID WELFARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5623315 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 87317 . This is a "CHILDRENS MEDICAL SECURIT" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA34401 . This is a "HARVARD PILGRIM HEALTHCAR" identifier . This identifiers is of the category "OTHER".




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