Healthcare Provider Details

I. General information

NPI: 1497799126
Provider Name (Legal Business Name): RICHARD GELLAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 LATROBE DR
CHARLOTTE NC
28211-4851
US

IV. Provider business mailing address

3303 LATROBE DRIVE
CHARLOTTE NC
28211
US

V. Phone/Fax

Practice location:
  • Phone: 704-362-2663
  • Fax: 704-362-2836
Mailing address:
  • Phone: 704-362-2663
  • Fax: 704-362-2836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number23271
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: