Provider Demographics
NPI:1891717393
Name:GELMAN, VADIM RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:VADIM
Middle Name:RICHARD
Last Name:GELMAN
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 1:3555 LOYOLA DR.
Mailing Address - Street 2:SUITE D
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2489
Mailing Address - Country:US
Mailing Address - Phone:504-464-8750
Mailing Address - Fax:
Practice Address - Street 1:3555 LOYOLA DR.
Practice Address - Street 2:SUITE D
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2489
Practice Address - Country:US
Practice Address - Phone:504-464-8750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12045R207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1697214Medicaid
5H315Medicare ID - Type Unspecified
LA1697214Medicaid