Provider Demographics
NPI:1629509641
Name:GASPER NEUROLOGY, LTD
Entity Type:Organization
Organization Name:GASPER NEUROLOGY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MASON
Authorized Official - Middle Name:
Authorized Official - Last Name:GASPER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:401-378-0258
Mailing Address - Street 1:900 RESERVOIR AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4453
Mailing Address - Country:US
Mailing Address - Phone:401-714-0222
Mailing Address - Fax:401-714-0220
Practice Address - Street 1:900 RESERVOIR AVE STE 1
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4453
Practice Address - Country:US
Practice Address - Phone:401-714-0222
Practice Address - Fax:401-714-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI006112084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RII37673Medicare UPIN