Provider Demographics
NPI:1932133592
Name:GASPER, JONATHAN L (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:L
Last Name:GASPER
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 1:149 MAIN ST
Mailing Address - Street 2:STE 2A
Mailing Address - City:WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04364-1486
Mailing Address - Country:US
Mailing Address - Phone:207-624-3800
Mailing Address - Fax:207-624-3845
Practice Address - Street 1:149 MAIN ST
Practice Address - Street 2:STE 2A
Practice Address - City:WINTHROP
Practice Address - State:ME
Practice Address - Zip Code:04364-1486
Practice Address - Country:US
Practice Address - Phone:207-624-3800
Practice Address - Fax:207-624-3845
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601152207Q00000X
ME018626207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904978Medicaid
NC5904978Medicaid
NC2055369Medicare PIN
ME001897901Medicare PIN