Provider Demographics
NPI:1073686127
Name:GELBART, JERRY HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:HENRY
Last Name:GELBART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MORAGA WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-3017
Mailing Address - Country:US
Mailing Address - Phone:925-254-3652
Mailing Address - Fax:
Practice Address - Street 1:11 MORAGA WAY STE 1
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-3017
Practice Address - Country:US
Practice Address - Phone:925-254-3652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG489552084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51222Medicare UPIN
CA00G489550Medicare ID - Type Unspecified