Individual
MARK ALAN GELLASCH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
BRANCH MEDICAL CLINIC NORFOLK, 1721 TAUSSIG BLVD, NORFOLK, VA 23511
(757) 314-6377
Mailing address
2753 SANDPIPER RD, VIRGINIA BEACH, VA 23456-4516
(757) 426-7700
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110000034
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0110000034
STATE MEDICAL LICENCE
VA
01
—
1003448
NATIONAL CERTIFICATION
—
Enumeration date
01/24/2006
Last updated
07/08/2007
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