Provider Demographics
NPI:1033661368
Name:GELLER, SCOTT (PA-C)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:GELLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 RYDAL RD
Mailing Address - Street 2:
Mailing Address - City:RYDAL
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1711
Mailing Address - Country:US
Mailing Address - Phone:267-620-1100
Mailing Address - Fax:215-572-1279
Practice Address - Street 1:1095 RYDAL RD
Practice Address - Street 2:
Practice Address - City:RYDAL
Practice Address - State:PA
Practice Address - Zip Code:19046-1711
Practice Address - Country:US
Practice Address - Phone:267-620-1100
Practice Address - Fax:215-572-1279
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA004780363A00000X
PAMA060532363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant