Healthcare Provider Details

I. General information

NPI: 1770057119
Provider Name (Legal Business Name): RYAN GELSINGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47149 BUSE RD BLDG 1370
PATUXENT RIVER MD
20670-1540
US

IV. Provider business mailing address

509 ROMPER RD
SNEADS FERRY NC
28460-9675
US

V. Phone/Fax

Practice location:
  • Phone: 301-342-5491
  • Fax:
Mailing address:
  • Phone: 201-230-5636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0101270349
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101270349
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: