Healthcare Provider Details

I. General information

NPI: 1861460743
Provider Name (Legal Business Name): DANIEL M GELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 PENDER DR SUITE 10
FAIRFAX VA
22030-0985
US

IV. Provider business mailing address

3930 PENDER DR SUITE 10
FAIRFAX VA
22030-0985
US

V. Phone/Fax

Practice location:
  • Phone: 703-273-2398
  • Fax: 703-273-0239
Mailing address:
  • Phone: 703-273-2398
  • Fax: 703-273-0239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101054544
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: