Provider Demographics
NPI:1972653152
Name:GELLER, SCHUYLER KEITH (MD, MPH)
Entity Type:Individual
Prefix:
First Name:SCHUYLER
Middle Name:KEITH
Last Name:GELLER
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 CLINCH VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:TREADWAY
Mailing Address - State:TN
Mailing Address - Zip Code:37881-2026
Mailing Address - Country:US
Mailing Address - Phone:423-754-0747
Mailing Address - Fax:
Practice Address - Street 1:917 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6527
Practice Address - Country:US
Practice Address - Phone:423-439-6464
Practice Address - Fax:423-439-7118
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101254986207RG0300X
TN12189207RG0300X, 208000000X, 207RA0401X
IN010256520A207RG0300X
IN01026520A2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I111496Medicare PIN
VAVVD313BMedicare PIN
TN103I119609Medicare PIN