Provider Demographics
NPI:1649238122
Name:VAN GELDEREN, GREGORY H (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:H
Last Name:VAN GELDEREN
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 1:2101 ELM STREET NORTH
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-8707
Mailing Address - Country:US
Mailing Address - Phone:701-239-3700
Mailing Address - Fax:
Practice Address - Street 1:2101 ELM ST N
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2417
Practice Address - Country:US
Practice Address - Phone:701-239-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBV6652502207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine