Provider Demographics
NPI:1013419118
Name:GASTON, LOUIS
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:
Last Name:GASTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GROVE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-1844
Mailing Address - Country:US
Mailing Address - Phone:203-559-1623
Mailing Address - Fax:
Practice Address - Street 1:101 GROVE ST APT 2
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-1844
Practice Address - Country:US
Practice Address - Phone:203-559-1623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT171W00000X
171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
473509807OtherTRANSPORTATION SERVICES
CT473509807OtherTRANSPORTATION SERVICES