Provider Demographics
NPI:1285637256
Name:MASKO, GABRIELA B (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIELA
Middle Name:B
Last Name:MASKO
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 1:825 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5707
Mailing Address - Country:US
Mailing Address - Phone:401-521-9700
Mailing Address - Fax:401-751-1686
Practice Address - Street 1:825 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5707
Practice Address - Country:US
Practice Address - Phone:401-521-9700
Practice Address - Fax:401-751-1686
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI070582085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7000160Medicaid
RI300020525OtherRR MEDICARE
MA110042588AMedicaid
RI700160Medicare PIN
MA110042588AMedicaid
B99129Medicare UPIN
RI7000160Medicaid