Healthcare Provider Details

I. General information

NPI: 1700977394
Provider Name (Legal Business Name): GILBERT RICHARD NELMES P.A,-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PENNSYLVANIA AVE SE STE 202
WASHINGTON DC
20003-4344
US

IV. Provider business mailing address

802 WALNUT AVE
NORTH BEACH MD
20714-9615
US

V. Phone/Fax

Practice location:
  • Phone: 202-544-5858
  • Fax:
Mailing address:
  • Phone: 301-461-3942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA30106DC
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: