Healthcare Provider Details

I. General information

NPI: 1982676276
Provider Name (Legal Business Name): ADAM K GELRUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 BROOK RD
RICHMOND VA
23227-2273
US

IV. Provider business mailing address

12900 PARK PLAZA DR STE 150
CERRITOS CA
90703-9329
US

V. Phone/Fax

Practice location:
  • Phone: 804-767-8400
  • Fax: 804-262-5113
Mailing address:
  • Phone: 562-977-4639
  • Fax: 562-741-7749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101234989
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: