Healthcare Provider Details

I. General information

NPI: 1649198946
Provider Name (Legal Business Name): BRUCE GARY GELLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 RESERVOIR RD NW
WASHINGTON DC
20007-2145
US

IV. Provider business mailing address

4000 RESERVOIR RD NW
WASHINGTON DC
20007-2145
US

V. Phone/Fax

Practice location:
  • Phone: 202-966-1013
  • Fax:
Mailing address:
  • Phone: 202-966-1013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberD0044114
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: