Provider Demographics
NPI:1013915354
Name:SAPERIA, GORDON M (MD)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:M
Last Name:SAPERIA
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 1:2065 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-2007
Mailing Address - Country:US
Mailing Address - Phone:508-868-3513
Mailing Address - Fax:
Practice Address - Street 1:750 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1526
Practice Address - Country:US
Practice Address - Phone:617-636-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44596207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
J04413 - M18187OtherBCBS
99001155 - 00115OtherFALLON
304582OtherHARVARD PILGRIM
MA3046664Medicaid
3123280OtherAETNA
772749OtherTUFTS
2210412004OtherCIGNA
974765OtherNETWORK HEALTH
304582OtherHARVARD PILGRIM
MA3046664Medicaid