Provider Demographics
NPI:1700011459
Name:GASPARINI, ANDREW V (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:V
Last Name:GASPARINI
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 1:2401 DEMERS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201
Mailing Address - Country:US
Mailing Address - Phone:701-780-1891
Mailing Address - Fax:
Practice Address - Street 1:725 HAMLINE ST - ALTRU FAMILY MEDICINE RESIDENCY
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203
Practice Address - Country:US
Practice Address - Phone:701-780-6800
Practice Address - Fax:218-935-2720
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNTP105148207Q00000X
MN53565207Q00000X
NDRL11211207Q00000X
ND11662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND15436Medicaid
NDN715752Medicare PIN
MN080019825Medicare PIN