Provider Demographics
NPI:1235944729
Name:GELA, DERESE
Entity type:Individual
Prefix:
First Name:DERESE
Middle Name:
Last Name:GELA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15628 WILLIAM BAYLISS CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-6072
Mailing Address - Country:US
Mailing Address - Phone:571-405-8974
Mailing Address - Fax:
Practice Address - Street 1:15628 WILLIAM BAYLISS CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-6072
Practice Address - Country:US
Practice Address - Phone:571-405-8974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No342000000XTransportation ServicesTransportation Network Company