1467432146 NPI number — NADIM A GELOO M.D.

Table of content: NADIM A GELOO M.D. (NPI 1467432146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467432146 NPI number — NADIM A GELOO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GELOO
Provider First Name:
NADIM
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467432146
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2901 TELESTAR CT.
Provider Second Line Business Mailing Address:
#300
Provider Business Mailing Address City Name:
FALLS CHURCH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22042-1263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-591-1688
Provider Business Mailing Address Fax Number:
703-591-1445

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2901 TELESTAR CT.
Provider Second Line Business Practice Location Address:
#200
Provider Business Practice Location Address City Name:
FALLS CHURCH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22042-1262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-573-3494
Provider Business Practice Location Address Fax Number:
703-573-5353
Provider Enumeration Date:
01/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  0101224504 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 0101224504 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1467432146 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com