Provider Demographics
NPI:1861944118
Name:GELMONT, DAVID MORDECHAI (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MORDECHAI
Last Name:GELMONT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4944 HOOD DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-4710
Mailing Address - Country:US
Mailing Address - Phone:818-914-9628
Mailing Address - Fax:818-914-4332
Practice Address - Street 1:4944 HOOD DR
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-4710
Practice Address - Country:US
Practice Address - Phone:818-914-9628
Practice Address - Fax:818-914-4332
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA034326207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA034326OtherMEDICAL LICENSE
AG8873350OtherDRUG ENFORCEMENT AGENCY (DEA)