Healthcare Provider Details

I. General information

NPI: 1033261383
Provider Name (Legal Business Name): GELDERMAN MEDICAL CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 SOUTH DUNLAP STREET
UNION WV
24983-0500
US

IV. Provider business mailing address

P O BOX 500 219 AT DUNLAP STREET
UNION WV
24983
US

V. Phone/Fax

Practice location:
  • Phone: 304-772-3211
  • Fax: 304-772-4991
Mailing address:
  • Phone: 304-772-3211
  • Fax: 304-772-4991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number09582
License Number StateWV

VIII. Authorized Official

Name: DR. ALBERT H GELDERMAN
Title or Position: OWNER
Credential: MD
Phone: 304-772-3211