Healthcare Provider Details

I. General information

NPI: 1720270143
Provider Name (Legal Business Name): FRED LEE GELIN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 12/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7809 WISE AVE
DUNDALK MD
21222-3339
US

IV. Provider business mailing address

7809 WISE AVE
DUNDALK MD
21222-3339
US

V. Phone/Fax

Practice location:
  • Phone: 410-288-0666
  • Fax: 410-288-0667
Mailing address:
  • Phone: 410-288-0666
  • Fax: 410-288-0667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number551
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: