Provider Demographics
NPI:1588657415
Name:ESPINO, GAGARINI TITOV (MD)
Entity Type:Individual
Prefix:DR
First Name:GAGARINI
Middle Name:TITOV
Last Name:ESPINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GAGARINI
Other - Middle Name:TITOV
Other - Last Name:ESPINO-RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 E 77TH ST
Mailing Address - Street 2:LENOX HILL HOSPITAL, RADIOLOGY DEPARTMENT, 3RD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1850
Mailing Address - Country:US
Mailing Address - Phone:212-434-2685
Mailing Address - Fax:212-434-2945
Practice Address - Street 1:100 E 77TH ST
Practice Address - Street 2:LENOX HILL HOSPITAL, RADIOLOGY DEPARTMENT, 3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1850
Practice Address - Country:US
Practice Address - Phone:212-434-2685
Practice Address - Fax:212-434-2945
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4327892085B0100X, 2085N0904X, 2085R0202X, 2085R0204X
NY1809892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD919374OtherCAREFIRST MD BCBS-WMG
PA2076065OtherHIGHMARK BLUE SHIELD-WMG
PA258292OtherUNISON
NY01600004Medicaid
MD035836300Medicaid
PA001886747Medicaid
PA1583308OtherGATEWAY-WMG
PA20077142OtherAMERIHEALTH MERCY-WMG
NYCC9806Medicare ID - Type Unspecified
PA001886747Medicaid
F61718Medicare UPIN