Healthcare Provider Details

I. General information

NPI: 1912996851
Provider Name (Legal Business Name): MARTIN K. GELBARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 15TH ST STE 1200
SANTA MONICA CA
90404-1147
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-7700
  • Fax: 310-394-5302
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberG35061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: