Provider Demographics
NPI:1093786402
Name:GELLER, DAVID SAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SAUL
Last Name:GELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:74 LOOMIS STREET
Practice Address - Street 2:PATRIOT PEDIATRICS
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-2248
Practice Address - Country:US
Practice Address - Phone:781-674-2900
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150518208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3153614Medicaid
MAJ17047OtherBCBS MA
MA150518OtherTUFTS HEALTH PLAN
A21375Medicare ID - Type Unspecified
MA3153614Medicaid