Healthcare Provider Details

I. General information

NPI: 1700952702
Provider Name (Legal Business Name): ELIOT MARC GELWAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MILL ST # AB335
BELMONT MA
02478-1048
US

IV. Provider business mailing address

82 PERRY ST
BROOKLINE MA
02446-6907
US

V. Phone/Fax

Practice location:
  • Phone: 617-855-3872
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number53266
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: