Healthcare Provider Details

I. General information

NPI: 1497771380
Provider Name (Legal Business Name): PENN VALLEY ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W WASHINGTON SQ 4TH FLOOR
PHILADELPHIA PA
19106-3500
US

IV. Provider business mailing address

PO BOX 874
ELMER NJ
08318-0874
US

V. Phone/Fax

Practice location:
  • Phone: 856-358-4520
  • Fax: 856-358-8053
Mailing address:
  • Phone: 856-358-4520
  • Fax: 856-358-8053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD026023E
License Number StatePA

VIII. Authorized Official

Name: MARC D GELLMAN
Title or Position: OWNER
Credential: M.D.
Phone: 856-358-4520