MEDICARE: STEPHEN A GELLER 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	174400000X	Specialist	G049703	CA

General Provider Information

NPI Number	:	1619979762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN A GELLER M.D.

Provider Business Mailing Address
First Line	:	31255 CEDAR VALLEY DR
Second Line	:	STE 324
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-7129
Country	:	US
Telephone Number	:	818-338-8103
Fax Number	:	818-338-8119

Provider Business Practice Location Address
First Line	:	8700 BEVERLY BLVD
Second Line	:	RM 8725
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90048-1804
Country	:	US
Telephone Number	:	310-423-6627
Fax Number	:	310-423-0170

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	09/06/2007

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