Healthcare Provider Details

I. General information

NPI: 1134168370
Provider Name (Legal Business Name): JUAN R GELPI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 FIRST COLONIAL RD SUITE 203
VIRGINIA BEACH VA
23454-2418
US

IV. Provider business mailing address

PO BOX 7068
PORTSMOUTH VA
23707-0068
US

V. Phone/Fax

Practice location:
  • Phone: 757-481-4424
  • Fax: 757-481-3820
Mailing address:
  • Phone: 757-686-3508
  • Fax: 757-481-3820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101054066
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: