Healthcare Provider Details

I. General information

NPI: 1548344526
Provider Name (Legal Business Name): MARC A. GELMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 3RD ST
SAN RAFAEL CA
94901-3107
US

IV. Provider business mailing address

1033 3RD ST
SAN RAFAEL CA
94901-3107
US

V. Phone/Fax

Practice location:
  • Phone: 415-482-6890
  • Fax: 415-482-6853
Mailing address:
  • Phone: 415-482-6890
  • Fax: 415-482-6853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG54202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: