Healthcare Provider Details

I. General information

NPI: 1548297443
Provider Name (Legal Business Name): DONALD J ZELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 INDUSTRIAL BLVD SUITE 202
PAOLI PA
19301-1632
US

IV. Provider business mailing address

11 INDUSTRIAL BLVD SUITE 202
PAOLI PA
19301-1632
US

V. Phone/Fax

Practice location:
  • Phone: 484-527-0410
  • Fax: 484-527-0415
Mailing address:
  • Phone: 484-527-0410
  • Fax: 484-527-0415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD031630E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: