Healthcare Provider Details

I. General information

NPI: 1366619025
Provider Name (Legal Business Name): GERTRUD M RASTALSKY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NAINA RASTALSKY M.D.

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CAMBRIDGE ST CCP 9
BRIGHTON MA
02135-2907
US

IV. Provider business mailing address

736 CAMBRIDGE ST CCP 9
BRIGHTON MA
02135-2907
US

V. Phone/Fax

Practice location:
  • Phone: 617-787-5111
  • Fax: 617-787-5150
Mailing address:
  • Phone: 617-787-5111
  • Fax: 617-787-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number235293
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number235293
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number235293
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: