Provider Demographics
NPI:1609841162
Name:GASPAR, MAURICE LEONARD (MD)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:LEONARD
Last Name:GASPAR
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 1:1635 N. GEORGE MASON DR.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3604
Mailing Address - Country:US
Mailing Address - Phone:703-524-5777
Mailing Address - Fax:703-908-9647
Practice Address - Street 1:1635 N. GEORGE MASON DR.
Practice Address - Street 2:SUITE 100
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3604
Practice Address - Country:US
Practice Address - Phone:703-524-5777
Practice Address - Fax:703-908-9647
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031899207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC415080Medicare ID - Type UnspecifiedDC METRO MEDICARE
C62666Medicare UPIN
415080A04Medicare PIN