Provider Demographics
NPI:1346495819
Name:GELLIS, MICHELLE (MAC LAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GELLIS
Suffix:
Gender:F
Credentials:MAC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8135 BROOKWOOD FARM RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-9658
Mailing Address - Country:US
Mailing Address - Phone:301-725-8927
Mailing Address - Fax:301-617-9724
Practice Address - Street 1:8135 BROOKWOOD FARM RD
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-9658
Practice Address - Country:US
Practice Address - Phone:301-725-8927
Practice Address - Fax:301-617-9724
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01407171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist