Provider Demographics
NPI:1417994146
Name:GELBURD, GREGORY S (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:S
Last Name:GELBURD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1583
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-1583
Mailing Address - Country:US
Mailing Address - Phone:434-654-7794
Mailing Address - Fax:434-654-7752
Practice Address - Street 1:310 AVON ST
Practice Address - Street 2:SUITE 9
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5750
Practice Address - Country:US
Practice Address - Phone:434-817-1818
Practice Address - Fax:434-817-9606
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102036993207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC83998Medicare UPIN
VA080007799Medicare PIN
VA080173286Medicare PIN