Provider Demographics
NPI:1982678546
Name:GASPAR, MELISSA M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:M
Last Name:GASPAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:GLAUDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1251 S CEDAR CREST BLVD
Mailing Address - Street 2:STE 203
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6205
Mailing Address - Country:US
Mailing Address - Phone:610-439-1662
Mailing Address - Fax:
Practice Address - Street 1:1251 S CEDAR CREST BLVD
Practice Address - Street 2:STE 203
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6205
Practice Address - Country:US
Practice Address - Phone:610-439-1662
Practice Address - Fax:610-439-8397
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002029363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP51523Medicare UPIN
PA091319NEZMedicare ID - Type Unspecified