Provider Demographics
NPI:1164470902
Name:GASTWIRTH, VANESSA GREEN (MD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:GREEN
Last Name:GASTWIRTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 N TENAYA WAY SUITE 460
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128
Mailing Address - Country:US
Mailing Address - Phone:702-233-1000
Mailing Address - Fax:702-233-1001
Practice Address - Street 1:3150 N TENAYA WAY SUITE 460
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-233-1000
Practice Address - Fax:702-233-1001
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35471207RC0000X
NV13801207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ102142Medicaid
AZ2009239 9965156OtherTRICARE
AZP00413309OtherRAILROAD MEDICARE
NV152971Medicare UPIN
AZ2009239 9965156OtherTRICARE
I52971Medicare UPIN