Provider Demographics
NPI:1114989761
Name:GASTMAN, BRIAN R (MD)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:R
Last Name:GASTMAN
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 1:9500 EUCLID AVENUE, A60
Mailing Address - Street 2:CLEVELAND CLINIC
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195
Mailing Address - Country:US
Mailing Address - Phone:216-444-6900
Mailing Address - Fax:216-444-9419
Practice Address - Street 1:9500 EUCLID AVENUE, A60
Practice Address - Street 2:CLEVELAND CLINIC
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195
Practice Address - Country:US
Practice Address - Phone:216-444-6900
Practice Address - Fax:216-444-9419
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063379207Y00000X, 208200000X, 2082S0099X
OH35.096183208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck