Provider Demographics
NPI:1093705725
Name:GELMAN, MARTIN L (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:L
Last Name:GELMAN
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 1:211 WEST STREET
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757
Mailing Address - Country:US
Mailing Address - Phone:617-782-4544
Mailing Address - Fax:617-787-9135
Practice Address - Street 1:211 WEST STREET
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757
Practice Address - Country:US
Practice Address - Phone:617-782-4544
Practice Address - Fax:617-787-9135
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35058207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0111511Medicaid
MAA 66821Medicare UPIN
MAM09035Medicare PIN