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General NPI Number Information
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NPI Number | 1194884098
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Entity Type | Individual
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Provider Name | DAVID ALLEN ZELLER JR. MPAS PA-C, APA, CCHP
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Gender | Male
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 2480 LLEWELLYN AVE STE 5800
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City | FORT MEADE
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State | MD
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Zip | 20755-5129
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Country | US
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Telephone | 253-677-7655
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1084
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City | BRANDON
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State | FL
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Zip | 33509-1084
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Country | US
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Telephone | 253-677-7655
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C07116
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA60277854
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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