Provider Demographics
NPI:1720010911
Name:GELFMAN, CHARLES LARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LARRY
Last Name:GELFMAN
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 1:1905 CLINT MOORE ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2660
Mailing Address - Country:US
Mailing Address - Phone:561-994-5454
Mailing Address - Fax:561-994-3943
Practice Address - Street 1:1905 CLINT MOORE ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2660
Practice Address - Country:US
Practice Address - Phone:561-994-5454
Practice Address - Fax:561-994-3943
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46432207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D57250Medicare UPIN
FLK1678Medicare ID - Type Unspecified