Provider Demographics
NPI:1366495194
Name:GELLMAN, MARC D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:D
Last Name:GELLMAN
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 1:82 BLUE HERON WAY
Mailing Address - Street 2:
Mailing Address - City:GIBBSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08026-1508
Mailing Address - Country:US
Mailing Address - Phone:856-435-4233
Mailing Address - Fax:856-435-4233
Practice Address - Street 1:82 BLUE HERRON WAY
Practice Address - Street 2:
Practice Address - City:GIBBSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08026-1508
Practice Address - Country:US
Practice Address - Phone:856-435-4233
Practice Address - Fax:856-435-4233
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026023E207L00000X
NJ25MA04206600207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009367460002Medicaid
PA092022Medicare PIN
E70589Medicare UPIN
PA0009367460002Medicaid