Provider Demographics
NPI:1952388118
Name:GASPAR, GEORGE ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ANTHONY
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 1:8091 RIVERS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9236
Mailing Address - Country:US
Mailing Address - Phone:843-572-5570
Mailing Address - Fax:843-572-4070
Practice Address - Street 1:8091 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9236
Practice Address - Country:US
Practice Address - Phone:843-572-5570
Practice Address - Fax:843-572-4070
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31702207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA79073Medicare UPIN
IL211332Medicare PIN
IL769380 - K16048Medicare ID - Type Unspecified