Provider Demographics
NPI:1366619025
Name:RASTALSKY, GERTRUD M (MD)
Entity type:Individual
Prefix:
First Name:GERTRUD
Middle Name:M
Last Name:RASTALSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAINA
Other - Middle Name:
Other - Last Name:RASTALSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:736 CAMBRIDGE ST
Mailing Address - Street 2:CCP 9
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2907
Mailing Address - Country:US
Mailing Address - Phone:617-787-5111
Mailing Address - Fax:617-787-5150
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:CCP 9
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-787-5111
Practice Address - Fax:617-787-5150
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235293207R00000X, 207RR0500X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine