Healthcare Provider Details

I. General information

NPI: 1265427694
Provider Name (Legal Business Name): JEFFREY S GELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 MERRIMACK ST STE 9
LAWRENCE MA
01843-1764
US

IV. Provider business mailing address

360 MERRIMACK ST STE 9
LAWRENCE MA
01843-1764
US

V. Phone/Fax

Practice location:
  • Phone: 978-655-6652
  • Fax: 789-655-6653
Mailing address:
  • Phone: 978-655-6652
  • Fax: 789-655-6653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number158759
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: