Healthcare Provider Details

I. General information

NPI: 1023576436
Provider Name (Legal Business Name): MARK J. GELLER, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 FREEPORT RD STE 200
BLAWNOX PA
15238-3411
US

IV. Provider business mailing address

121 FREEPORT RD STE 200
BLAWNOX PA
15238-3411
US

V. Phone/Fax

Practice location:
  • Phone: 412-639-1770
  • Fax: 412-487-1913
Mailing address:
  • Phone: 412-639-1770
  • Fax: 412-487-1913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK J GELLER
Title or Position: OWNER
Credential: MD
Phone: 412-639-1770