Healthcare Provider Details

I. General information

NPI: 1790768752
Provider Name (Legal Business Name): JEFFREY L. GELLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 11/22/2020
Certification Date: 11/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CENTURY DR
WORCESTER MA
01606-1244
US

IV. Provider business mailing address

PO BOX 415348
BOSTON MA
02241-5348
US

V. Phone/Fax

Practice location:
  • Phone: 508-762-5400
  • Fax: 508-762-5410
Mailing address:
  • Phone: 800-225-8885
  • Fax: 508-334-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number38115
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: