Provider Demographics
NPI:1366468357
Name:GLADSTONE, GERALD CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:CHARLES
Last Name:GLADSTONE
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 1:10 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-4435
Mailing Address - Country:US
Mailing Address - Phone:508-757-6330
Mailing Address - Fax:508-792-6717
Practice Address - Street 1:10 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4435
Practice Address - Country:US
Practice Address - Phone:508-757-6330
Practice Address - Fax:508-792-6717
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2016-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA43578207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA711303OtherTUFTS HEALTH PLAN
MAB11640OtherBLUE CROSS BLUE SHIELD
MA2071517Medicaid
MA4172OtherHARVARD PILGRIM HEALTH
MA4258OtherFALLON HEALTH PLAN
A33978Medicare UPIN
MAB11640Medicare PIN
MAB11640Medicare PIN