Healthcare Provider Details

I. General information

NPI: 1417994146
Provider Name (Legal Business Name): GREGORY S. GELBURD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 AVON ST SUITE 9
CHARLOTTESVILLE VA
22902-5750
US

IV. Provider business mailing address

PO BOX 1583
CHARLOTTESVILLE VA
22902-1583
US

V. Phone/Fax

Practice location:
  • Phone: 434-817-1818
  • Fax: 434-817-9606
Mailing address:
  • Phone: 434-654-7794
  • Fax: 434-654-7752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102036993
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: