MEDICARE: MASON C GASPER DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	223324	MA
2	2084N0400X	Neurology Physician	DO00611	RI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	A3870402	OTHER	RI	MEDICARE PTAN
10	007058833	OTHER	RI	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	7238673	OTHER	AETNA US HEALTHCARE
3	042472266	OTHER	TRICARE CHAMPUS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	468304	OTHER	TUFTS HEALTH PLAN
6	87317	OTHER	HEALTHY START
7	92597	OTHER	FALLON COMMUNITY HEALTH P
8	042472266	OTHER	PRIVATE HEALTHCARE SYSTEM
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	J29259	OTHER	BLUE CARE ELECT
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	5623315	OTHER	FIRST HEALTH
14	87317	OTHER	CHILDRENS MEDICAL SECURIT
15	AA34401	OTHER	HARVARD PILGRIM HEALTHCAR

General Provider Information

NPI Number	:	1245211788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MASON C GASPER DO

Provider Business Mailing Address
First Line	:	900 RESERVOIR AVE STE 1
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02910-4453
Country	:	US
Telephone Number	:	401-714-0222
Fax Number	:	401-714-0220

Provider Business Practice Location Address
First Line	:	900 RESERVOIR AVE STE 1
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02910-4453
Country	:	US
Telephone Number	:	401-714-0222
Fax Number	:	401-714-0220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	11/14/2019

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Directions to “ MASON C GASPER DO” Practice Location

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