Provider Demographics
NPI:1245211788
Name:GASPER, MASON C (DO)
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:C
Last Name:GASPER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:900 RESERVOIR AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4453
Mailing Address - Country:US
Mailing Address - Phone:401-714-0222
Mailing Address - Fax:401-714-0220
Practice Address - Street 1:900 RESERVOIR AVE STE 1
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4453
Practice Address - Country:US
Practice Address - Phone:401-714-0222
Practice Address - Fax:401-714-0220
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2233242084N0400X
RIDO006112084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
7238673OtherAETNA US HEALTHCARE
RIA3870402OtherMEDICARE PTAN
042472266OtherTRICARE CHAMPUS
RI7058831Medicaid
468304OtherTUFTS HEALTH PLAN
87317OtherHEALTHY START
92597OtherFALLON COMMUNITY HEALTH P
042472266OtherPRIVATE HEALTHCARE SYSTEM
MA2102242Medicaid
RI007058833OtherMEDICARE PTAN
J29259OtherBLUE CARE ELECT
2102242OtherMEDICAID WELFARE
5623315OtherFIRST HEALTH
87317OtherCHILDRENS MEDICAL SECURIT
AA34401OtherHARVARD PILGRIM HEALTHCAR
AA34401OtherHARVARD PILGRIM HEALTHCAR