Healthcare Provider Details

I. General information

NPI: 1235697640
Provider Name (Legal Business Name): RYAN GELFAND PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9104 BABCOCK BLVD
PITTSBURGH PA
15237-5818
US

IV. Provider business mailing address

4841 JOYFUL WAY APT J
ELLICOTT CITY MD
21043-8026
US

V. Phone/Fax

Practice location:
  • Phone: 412-367-5020
  • Fax:
Mailing address:
  • Phone: 240-750-9678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC07534
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: