Provider Demographics
NPI:1083885727
Name:EDMUND A GELLER M D P A
Entity Type:Organization
Organization Name:EDMUND A GELLER M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:A
Authorized Official - Last Name:GELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-437-7358
Mailing Address - Street 1:1 SW 129TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1761
Mailing Address - Country:US
Mailing Address - Phone:954-437-7358
Mailing Address - Fax:954-437-4197
Practice Address - Street 1:1 SW 129TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1761
Practice Address - Country:US
Practice Address - Phone:954-437-7358
Practice Address - Fax:954-437-4197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39306207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAJ651Medicare PIN