Provider Demographics
NPI:1598759706
Name:GASPAROVICH, MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:GASPAROVICH
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 1:2977 4H PARK RD STE 202
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21617-2226
Mailing Address - Country:US
Mailing Address - Phone:410-989-9859
Mailing Address - Fax:877-451-0302
Practice Address - Street 1:2977 4H PARK RD STE 202
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-2226
Practice Address - Country:US
Practice Address - Phone:410-989-9859
Practice Address - Fax:877-451-0302
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0067888207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02228820Medicaid
DD0990Medicare PIN
NY02228820Medicaid
RA0908Medicare ID - Type Unspecified