Provider Demographics
NPI:1861460743
Name:GELLER, DANIEL M (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:M
Last Name:GELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3930 PENDER DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-0985
Mailing Address - Country:US
Mailing Address - Phone:703-273-2398
Mailing Address - Fax:703-273-0239
Practice Address - Street 1:3930 PENDER DR
Practice Address - Street 2:SUITE 10
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-0985
Practice Address - Country:US
Practice Address - Phone:703-273-2398
Practice Address - Fax:703-273-0239
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2010-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101054544207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101054544Medicaid
VA00A100D66Medicare ID - Type Unspecified
G30716Medicare UPIN