Provider Demographics
NPI:1235626821
Name:GASTALDO, NICHOLAS ALEXANDER (DO)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ALEXANDER
Last Name:GASTALDO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9902 KINGSBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-1613
Mailing Address - Country:US
Mailing Address - Phone:614-531-2256
Mailing Address - Fax:
Practice Address - Street 1:627 EASTLAND AVE SE STE 201
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4501
Practice Address - Country:US
Practice Address - Phone:330-841-4477
Practice Address - Fax:330-841-4505
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0102207760208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program