Healthcare Provider Details

I. General information

NPI: 1952388118
Provider Name (Legal Business Name): GEORGE ANTHONY GASPAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8091 RIVERS AVE
NORTH CHARLESTON SC
29406-9236
US

IV. Provider business mailing address

8091 RIVERS AVE
NORTH CHARLESTON SC
29406-9236
US

V. Phone/Fax

Practice location:
  • Phone: 843-572-5570
  • Fax: 843-572-4070
Mailing address:
  • Phone: 843-572-5570
  • Fax: 843-572-4070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number31702
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31702
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: