Healthcare Provider Details

I. General information

NPI: 1548580368
Provider Name (Legal Business Name): DAVID GELLIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 VETERANS MEMORIAL PKWY # 15B
EAST PROVIDENCE RI
02914-5300
US

IV. Provider business mailing address

106 NATE WHIPPLE HWY STE 101
CUMBERLAND RI
02864-1403
US

V. Phone/Fax

Practice location:
  • Phone: 401-434-3350
  • Fax: 401-434-5230
Mailing address:
  • Phone: 401-658-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number54527
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21872
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60749731
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0056950
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number74959
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number270640
License Number StateMA
# 7
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD20035
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: