Provider Demographics
NPI:1275618688
Name:WELLER, GISELLE S (MD)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:S
Last Name:WELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GISELLE
Other - Middle Name:M
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 636256
Mailing Address - Street 2:CENTRAL CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5502
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:231 ALBERT SABIN WAY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-2827
Practice Address - Country:US
Practice Address - Phone:513-584-4457
Practice Address - Fax:513-584-2222
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0825092080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine