Healthcare Provider Details

I. General information

NPI: 1396709069
Provider Name (Legal Business Name): MARK J GELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 FREEPORT RD STE 200
BLAWNOX PA
15238-3485
US

IV. Provider business mailing address

121 FREEPORT RD STE 200
BLAWNOX PA
15238-3485
US

V. Phone/Fax

Practice location:
  • Phone: 412-965-3335
  • Fax: 412-487-1913
Mailing address:
  • Phone: 412-965-3335
  • Fax: 412-487-1913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD029608E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD029608E
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD-029608-E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: