Healthcare Provider Details

I. General information

NPI: 1821018771
Provider Name (Legal Business Name): ALBERT GELLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S ELLSWORTH AVE STE 308
SAN MATEO CA
94401-3931
US

IV. Provider business mailing address

100 S ELLSWORTH AVE STE 308
SAN MATEO CA
94401-3931
US

V. Phone/Fax

Practice location:
  • Phone: 650-344-6896
  • Fax: 650-344-2794
Mailing address:
  • Phone: 650-344-6896
  • Fax: 650-344-2794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberC31765
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: