Provider Demographics
NPI:1730186818
Name:GENDELMAN, DAVID S (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:GENDELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:172 CAMBRIDGE STREET
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803
Mailing Address - Country:US
Mailing Address - Phone:617-202-2020
Mailing Address - Fax:617-734-3264
Practice Address - Street 1:24 WEBSTER PL
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7937
Practice Address - Country:US
Practice Address - Phone:781-272-4944
Practice Address - Fax:781-272-8756
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA55101207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
043070848015OtherBCBS
108OtherSECURE HORIZONS NEEC
MA3001067Medicaid
8180OtherCIGNA HEALTHSOURCE
GEJ04746OtherREGENCE BLUE SHIELD
GEJ04746OtherEMPIRE BCBS
991743OtherNETWORK HEALTH
GEJ04746OtherBCBS PPO
GEJ04746OtherBCBS OF PENNSYLVANIA
15316OtherHARVARD COMM HEALTH
GEJ04746OtherBCBS OF CONNECTICUT
GEJ04746OtherBLUE SHIELD
GEJ04746OtherBCBS OF MA
0800236OtherUNITED HEALTHCARE
GEJ04746OtherBCBS OF OREGON
GEJ04746OtherBCBC OF ILLINOIS
CE5062OtherRAILROAD MEDICARE
GEJ04746OtherHORIZON BCBS OF NJ
GEJ04746OtherBCBS
CE5062OtherRAILROAD MEDICARE
GEJ04746OtherHORIZON BCBS OF NJ