Provider Demographics
NPI:1942200688
Name:ELLER, MARC A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:A
Last Name:ELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 ALMA LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-4012
Mailing Address - Country:US
Mailing Address - Phone:703-642-5990
Mailing Address - Fax:703-642-5003
Practice Address - Street 1:5510 ALMA LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-4012
Practice Address - Country:US
Practice Address - Phone:703-642-5990
Practice Address - Fax:703-642-5003
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044984207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA205693OtherANTHEM HEALTHKEEPERS
VA205693OtherTRIGON KEYAD
VA5325453-019OtherCIGNA HMO
VA125579OtherONE HEALTH GREATWEST
VA257640OtherMDIPA/OPTIMUM CHOICE/MAMS
VA45560010OtherBCBS DC/CAPCARE
VA505110OtherNCPPO
VA5635110Medicaid
VA0101444OtherUNITED HEALTH MID-ATLANTI
VA0101471OtherUNITED HEALTH VIRGINIA
VA5298516OtherAHP MGD CHOICE
VA1068214OtherAFFORDABLE FIRST HEALTH
VA2009266OtherAETNA/US HEALTHCARE
VA1068214OtherAFFORDABLE FIRST HEALTH
VA5635110Medicaid