Provider Demographics
NPI:1184794331
Name:GELLINEAU, VICTOR MARCEL III (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:MARCEL
Last Name:GELLINEAU
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 746724
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6724
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:773-866-8014
Practice Address - Street 1:4600 CAPITAL BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-4478
Practice Address - Country:US
Practice Address - Phone:919-980-7008
Practice Address - Fax:919-336-4528
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2021-09-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2021-02186207Q00000X
CAA75952207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH69850Medicare ID - Type UnspecifiedFAMILY PRACTICE