Provider Demographics
NPI:1629040282
Name:GELLER, ALAN E (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:E
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 1:90 LIBBEY PKWY
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-3100
Mailing Address - Country:US
Mailing Address - Phone:781-335-3900
Mailing Address - Fax:781-340-3782
Practice Address - Street 1:90 LIBBEY PKWY
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3100
Practice Address - Country:US
Practice Address - Phone:781-335-3900
Practice Address - Fax:781-340-3782
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA350502084P0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAK08300Medicare ID - Type Unspecified
MAB75265Medicare UPIN