Active NPI
Gerald Charles Gladstone, MD
- Dermatology Physician
- Worcester, MA
National Provider Identifier
1366468357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 43578
- Practice address
- 10 Winthrop St
Worcester, MA 01604-4435 - Phone
- (508) 757-6330
- Fax
- (508) 792-6717
- NPI assigned
- Jul 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 43578 | MA | Primary |
Addresses
Primary practice location
10 Winthrop St
Worcester, MA 01604-4435
Mailing address
10 Winthrop St
Worcester, MA 01604-4435
Phone (508) 757-6330
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 711303 | Other | MA | TUFTS HEALTH PLAN |
| B11640 | Other | MA | BLUE CROSS BLUE SHIELD |
| 2071517 | Medicaid | MA | |
| 4172 | Other | MA | HARVARD PILGRIM HEALTH |
| 4258 | Other | MA | FALLON HEALTH PLAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43578 | MA | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460764800000",
"number": "1366468357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 WINTHROP ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016044435",
"telephone_number": "508-757-6330",
"fax_number": "508-792-6717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 WINTHROP ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016044435",
"telephone_number": "508-757-6330",
"fax_number": "508-792-6717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLADSTONE",
"first_name": "GERALD",
"middle_name": "CHARLES",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-14",
"last_updated": "2016-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "MA",
"license": "43578",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH PLAN",
"identifier": "711303",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "B11640",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2071517",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM HEALTH",
"identifier": "4172",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FALLON HEALTH PLAN",
"identifier": "4258",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.