Healthcare Provider Details

I. General information

NPI: 1053754358
Provider Name (Legal Business Name): JONATHAN GELLMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 N CENTER DR STE 206
NORFOLK VA
23502-4008
US

IV. Provider business mailing address

6330 N CENTER DR STE 206
NORFOLK VA
23502-4008
US

V. Phone/Fax

Practice location:
  • Phone: 757-335-6657
  • Fax: 757-351-4255
Mailing address:
  • Phone: 757-335-6657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101258584
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number0101258584
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: