Provider Demographics
NPI:1932132586
Name:GASTESI, ROMAN AMABLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:AMABLE
Last Name:GASTESI
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 1:816 NE 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3036
Mailing Address - Country:US
Mailing Address - Phone:954-463-0070
Mailing Address - Fax:954-463-7014
Practice Address - Street 1:816 NE 20TH AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3036
Practice Address - Country:US
Practice Address - Phone:954-463-0070
Practice Address - Fax:954-463-7014
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME17960207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD60436Medicare UPIN
FL93340Medicare ID - Type Unspecified