Basic Information
| Provider Information | |||||||||
| NPI: | 1982676276 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GELRUD | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12900 PARK PLAZA DR STE 150 | ||||||||
| Address2: | |||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907039329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629774639 | ||||||||
| FaxNumber: | 5627417749 | ||||||||
| Practice Location | |||||||||
| Address1: | 5620 BROOK RD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232272273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8047678400 | ||||||||
| FaxNumber: | 8042625113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 08/30/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101234989 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00145319 | 01 | VA | RAILROAD MEDICARE | OTHER | 010078369 | 05 | VA | MEDICAID | 010236703 | 05 | VA | MEDICAID | 188196 | 01 | VA | BCBS | OTHER | 139730 | 01 | VA | BCBS | OTHER |