Provider Demographics
NPI:1952313363
Name:GASPAR, VLADIMIR (MD)
Entity Type:Individual
Prefix:DR
First Name:VLADIMIR
Middle Name:
Last Name:GASPAR
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 1:8745 LAKE RD
Mailing Address - Street 2:STE 1
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-9344
Mailing Address - Country:US
Mailing Address - Phone:585-768-2620
Mailing Address - Fax:585-768-2694
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 278980
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-768-2620
Practice Address - Fax:585-768-2694
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY102908BFOtherPREFERRED CARE
NYP040205320OtherBCBS ROCHESTER
NY000911435008OtherBCBS WNY
NY00020921805OtherUNIVERA
NYP010205320OtherBLUE CHOICE
NY0110905OtherINDEPENDENT HEALTH
NY01668455Medicaid
NY102908BFOtherPREFERRED CARE
G00851Medicare UPIN