Provider Demographics
NPI:1720270143
Name:GELIN, FRED LEE (DPM)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:LEE
Last Name:GELIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7809 WISE AVE
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-3339
Mailing Address - Country:US
Mailing Address - Phone:410-288-0666
Mailing Address - Fax:410-288-0667
Practice Address - Street 1:7809 WISE AVE
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-3339
Practice Address - Country:US
Practice Address - Phone:410-288-0666
Practice Address - Fax:410-288-0667
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD551213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD769638800Medicaid
MD769638800Medicaid