MEDICARE: RICHARD LEE ELLER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD024193E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	VAD000	OTHER		DEPT OF VETERANS AFFAIRS

General Provider Information

NPI Number	:	1609892512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD LEE ELLER M.D.

Provider Business Mailing Address
First Line	:	1537 ELMIRA ST
Second Line	:
City	:	SAYRE
State	:	PA
Zip	:	18840-9254
Country	:	US
Telephone Number	:	570-888-6803
Fax Number	:	570-888-2025

Provider Business Practice Location Address
First Line	:	1537 ELMIRA ST
Second Line	:
City	:	SAYRE
State	:	PA
Zip	:	18840-9254
Country	:	US
Telephone Number	:	570-888-6803
Fax Number	:	570-888-2025

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	09/10/2010

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