Gellasch, Mark Alan

Gellasch, Mark Alan is an individual health care provider with primary practice located at Branch Medical Clinic Norfolk 1721 Taussig Blvd, Norfolk VA 23511. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Gellasch, Mark Alan can be contacted via phone (757) 314-6377.

Contact Information

Primary practice address
Branch Medical Clinic Norfolk 1721 Taussig Blvd Norfolk VA 23511
Phone: (757) 314-6377
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 0110000034 Virginia

Profile Details

NPI number 1902876931
LBN Legal business name Gellasch, Mark Alan
Credentials PHYSICIAN ASSISTANT
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 24th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902876931 NPPES
Virginia Other 0110000034 STATE MEDICAL LICENCE
Virginia Other 1003448 STATE MEDICAL LICENCE

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