Provider Demographics
NPI:1235626821
Name:GASTALDO, NICHOLAS ALEXANDER (DO)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ALEXANDER
Last Name:GASTALDO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4515 DESANTIS CT APT 214
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2784
Mailing Address - Country:US
Mailing Address - Phone:614-531-2256
Mailing Address - Fax:
Practice Address - Street 1:3580 JOSEPH SIEWICK DR STE 205
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1764
Practice Address - Country:US
Practice Address - Phone:703-620-3211
Practice Address - Fax:703-620-3215
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0102207760208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program