Provider Demographics
NPI:1649210329
Name:GELLRICK, CAROLINE M (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:M
Last Name:GELLRICK
Suffix:
Gender:F
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:DEPT 557
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-0557
Mailing Address - Country:US
Mailing Address - Phone:303-467-4155
Mailing Address - Fax:303-467-4156
Practice Address - Street 1:9830 I-70 FRONTAGE RD SOUTH
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033
Practice Address - Country:US
Practice Address - Phone:303-467-4100
Practice Address - Fax:303-420-0836
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21414207Q00000X, 207QA0401X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01214147Medicaid
080114815OtherMEDICARE RAILROAD
D84544Medicare UPIN
COC163158Medicare PIN