Provider Demographics
NPI:1245459734
Name:GASPAR, DIANE A (PA - C)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:A
Last Name:GASPAR
Suffix:
Gender:F
Credentials:PA - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11055 LITTLE PATUXENT PKWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2896
Mailing Address - Country:US
Mailing Address - Phone:410-730-6673
Mailing Address - Fax:410-730-8226
Practice Address - Street 1:11055 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 106
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2896
Practice Address - Country:US
Practice Address - Phone:410-730-6673
Practice Address - Fax:410-730-8226
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0000895363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S935K675Medicare ID - Type UnspecifiedMEDICARE PA PROVIDER NO.