Provider Demographics
NPI:1851491567
Name:GOSTANIAN, GERALD T (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:T
Last Name:GOSTANIAN
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:PO BOX 7985
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-7985
Mailing Address - Country:US
Mailing Address - Phone:949-640-4650
Mailing Address - Fax:
Practice Address - Street 1:400 NEWPORT CENTER DR STE 202A
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7680
Practice Address - Country:US
Practice Address - Phone:949-640-4650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23346Medicare UPIN