Provider Demographics
NPI:1093710345
Name:GELLER, MARK L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:GELLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9602
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91346-9602
Mailing Address - Country:US
Mailing Address - Phone:818-837-5559
Mailing Address - Fax:818-792-4793
Practice Address - Street 1:18133 VENTURA BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3641
Practice Address - Country:US
Practice Address - Phone:818-466-7700
Practice Address - Fax:818-996-1649
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2018-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG60287207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT0796OtherRAILROAD GROUP NUMBER
CAWG60287AOtherMEDICARE RENDERING NUMBER
CA110061982OtherRAILROAD RENDERING NUMBER
CAYYY40048YMedicaid
CA95-3132732OtherBLUE CROSS OF CALIFORNIA
CAYYY40048YOtherBLUE SHIELD OF CALIFORNIA
CAWG60287AOtherMEDICARE RENDERING NUMBER
CAF38967Medicare UPIN