Provider Demographics
NPI:1508837550
Name:GASPERACK, DAVID JAMES (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
Last Name:GASPERACK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-656-6122
Mailing Address - Fax:717-656-0142
Practice Address - Street 1:368 W MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LEOLA
Practice Address - State:PA
Practice Address - Zip Code:17540-1761
Practice Address - Country:US
Practice Address - Phone:717-656-6122
Practice Address - Fax:717-656-0142
Is Sole Proprietor?:No
Enumeration Date:2006-01-29
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-013187207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
001871953OtherBLUE SHIELD
50059819OtherBLUE CROSS
102285UFWMedicare PIN
001871953OtherBLUE SHIELD