Healthcare Provider Details

I. General information

NPI: 1629040282
Provider Name (Legal Business Name): ALAN E GELLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 LIBBEY PKWY
WEYMOUTH MA
02189-3100
US

IV. Provider business mailing address

90 LIBBEY PKWY
WEYMOUTH MA
02189-3100
US

V. Phone/Fax

Practice location:
  • Phone: 781-335-3900
  • Fax: 781-340-3782
Mailing address:
  • Phone: 781-335-3900
  • Fax: 781-340-3782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0005X
TaxonomyNeurodevelopmental Disabilities Physician
License Number35050
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: