1386641652 NPI number — DR. FRED GELIN PA

Table of content: (NPI 1386641652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386641652 NPI number — DR. FRED GELIN PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. FRED GELIN PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1386641652
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7809 WISE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21222-3339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-288-0666
Provider Business Mailing Address Fax Number:
410-288-0667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7809 WISE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21222-3339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-288-0666
Provider Business Practice Location Address Fax Number:
410-288-0667
Provider Enumeration Date:
07/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GELIN
Authorized Official First Name:
FRED
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-288-0666

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  551 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 319788 . This is a "MDIPA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4379918 . This is a "AETNA PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R003-0001 . This is a "BC/BS FEDERAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 319788 . This is a "OPTIMUM CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 319788 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3584341 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 769638800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: T159FR . This is a "BC/BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R003-0001 . This is a "BC/BS BLUECHOICE" identifier . This identifiers is of the category "OTHER".




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