Healthcare Provider Details

I. General information

NPI: 1386063436
Provider Name (Legal Business Name): ELISE SARA GELWAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N BROADWAY ST
BALTIMORE MD
21287
US

IV. Provider business mailing address

80 SEYMOUR ST
HARTFORD CT
06106-3315
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-3580
  • Fax: 410-550-0075
Mailing address:
  • Phone: 860-972-2249
  • Fax: 860-545-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberD84534
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number065159
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: