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General NPI Number Information
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NPI Number | 1184794331
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Entity Type | Individual
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Provider Name | VICTOR MARCEL GELLINEAU III M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 4600 CAPITAL BLVD
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City | RALEIGH
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State | NC
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Zip | 27604-4478
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Country | US
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Telephone | 919-980-7008
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Fax | 919-336-4528
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Provider Business Mailing Address
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Address Line | PO BOX 746724
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City | ATLANTA
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State | GA
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Zip | 30374-6724
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Country | US
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Telephone | 312-733-9730
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Fax | 773-866-8014
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2021-02186
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A75952
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License Number State | CA
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