Basic Information
| Provider Information | |||||||||
| NPI: | 1093908840 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GASPARINE | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2854 BELL ST | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437011721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404543273 | ||||||||
| FaxNumber: | 7405881081 | ||||||||
| Practice Location | |||||||||
| Address1: | 2854 BELL ST | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437011721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404543273 | ||||||||
| FaxNumber: | 7405881081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2007 | ||||||||
| LastUpdateDate: | 05/03/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | TRN11106 | FL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207QS0010X | 35097446 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0051428 | 05 | OH | MEDICAID |