Healthcare Provider Details

I. General information

NPI: 1770724767
Provider Name (Legal Business Name): ANGELLE MARIE GELVIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2009
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 RIVER RD
JEFFERSON LA
70121-4227
US

IV. Provider business mailing address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-6406
  • Fax:
Mailing address:
  • Phone: 504-842-3000
  • Fax: 504-891-9893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD.204863
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: