Healthcare Provider Details

I. General information

NPI: 1477675072
Provider Name (Legal Business Name): ELIZABETH J GELLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR
CHAPEL HILL NC
27599-0001
US

IV. Provider business mailing address

CB 7570 OLD CLINIC DEPT OB/GYN
CHAPEL HILL NC
27599-7570
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-4131
  • Fax:
Mailing address:
  • Phone: 919-966-4717
  • Fax: 919-843-9952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number200500336
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number2005-00336
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: