Basic Information
| Provider Information | |||||||||
| NPI: | 1649210329 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GELLRICK | ||||||||
| FirstName: | CAROLINE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 557 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802910557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034674155 | ||||||||
| FaxNumber: | 3034674156 | ||||||||
| Practice Location | |||||||||
| Address1: | 9830 I-70 FRONTAGE RD SOUTH | ||||||||
| Address2: | |||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034674100 | ||||||||
| FaxNumber: | 3034200836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 09/30/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 21414 | CO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QA0401X | 21414 | CO | N | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | 2083X0100X | 21414 | CO | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01214147 | 05 | CO | MEDICAID | 080114815 | 01 | MEDICARE RAILROAD | OTHER |