Provider Demographics
NPI:1538110267
Name:GELFMAN, WAYNE T (NP)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:T
Last Name:GELFMAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:131 EMERALD ST
Mailing Address - Street 2:WRENTHAM DEVELOPMENTAL CENTER
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1902
Mailing Address - Country:US
Mailing Address - Phone:508-384-3114
Mailing Address - Fax:508-384-8938
Practice Address - Street 1:131 EMERALD ST
Practice Address - Street 2:WRENTHAM DEVELOPMENTAL CENTER
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1902
Practice Address - Country:US
Practice Address - Phone:508-384-3114
Practice Address - Fax:508-384-8938
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA162663363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2794Medicare ID - Type Unspecified