Provider Demographics
NPI:1386641652
Name:DR. FRED GELIN PA
Entity Type:Organization
Organization Name:DR. FRED GELIN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:GELIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-288-0666
Mailing Address - Street 1:7809 WISE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-3339
Mailing Address - Country:US
Mailing Address - Phone:410-288-0666
Mailing Address - Fax:410-288-0667
Practice Address - Street 1:7809 WISE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222-3339
Practice Address - Country:US
Practice Address - Phone:410-288-0666
Practice Address - Fax:410-288-0667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD551213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD319788OtherMDIPA
MD4379918OtherAETNA PPO
R003-0001OtherBC/BS FEDERAL
MD319788OtherOPTIMUM CHOICE
MD319788OtherMAMSI
MD3584341OtherAETNA HMO
MD769638800Medicaid
MDT159FROtherBC/BS
R003-0001OtherBC/BS BLUECHOICE
MD319788OtherMAMSI
MDT83572Medicare UPIN
R003-0001OtherBC/BS FEDERAL