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:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:617-202-2020
Practice Address - Fax:617-734-3264
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55101207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0800236OtherUNITED HEALTHCARE
8180OtherCIGNA HEALTHSOURCE
GEJ04746OtherBCBS OF CONNECTICUT
GEJ04746OtherBCBS PPO
043070848015OtherBCBS
GEJ04746OtherEMPIRE BCBS
GEJ04746OtherBCBS OF OREGON
GEJ04746OtherBCBS
GEJ04746OtherBCBS OF PENNSYLVANIA
15316OtherHARVARD COMM HEALTH
991743OtherNETWORK HEALTH
GEJ04746OtherBCBC OF ILLINOIS
GEJ04746OtherBLUE SHIELD
GEJ04746OtherBCBS OF MA
GEJ04746OtherREGENCE BLUE SHIELD
108OtherSECURE HORIZONS NEEC
CE5062OtherRAILROAD MEDICARE
MA3001067Medicaid
GEJ04746OtherHORIZON BCBS OF NJ
CE5062OtherRAILROAD MEDICARE
GEJ04746OtherHORIZON BCBS OF NJ