Healthcare Provider Details

I. General information

NPI: 1124199229
Provider Name (Legal Business Name): DEEPAK RAMCHANDRA GELOT. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 W KING ST
KINGS MOUNTAIN NC
28086-2707
US

IV. Provider business mailing address

707 W KING ST
KINGS MOUNTAIN NC
28086-2707
US

V. Phone/Fax

Practice location:
  • Phone: 704-734-0001
  • Fax:
Mailing address:
  • Phone: 704-734-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36627
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: