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General NPI Number Information
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NPI Number | 1487072393
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Entity Type | Individual
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Provider Name | OLIVIA TELLE VAN GERWEN MD
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Gender | Female
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Dates
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Enumeration Date | 03/29/2014
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 1717 6TH AVE S
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City | BIRMINGHAM
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State | AL
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Zip | 35233-1801
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Country | US
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Telephone | 800-822-8816
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Fax |
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Provider Business Mailing Address
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Address Line | 703 19TH STREET SOUTH ZRB 218A
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City | BIRMINGHAM
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State | AL
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Zip | 35294-0001
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Country | US
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Telephone | 205-934-0081
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Fax | 205-801-5607
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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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 36962
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License Number State | AL
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