1770057119 NPI number — RYAN GELSINGER

Table of content: RYAN GELSINGER (NPI 1770057119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770057119 NPI number — RYAN GELSINGER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GELSINGER
Provider First Name:
RYAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1770057119
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
509 ROMPER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SNEADS FERRY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28460-9675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-230-5636
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
47149 BUSE RD BLDG 1370
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PATUXENT RIVER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20670-1540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-342-5491
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/18/2019

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: 171000000X , with the licence number:  0101270349 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 0101270349 , 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)