Provider Demographics
NPI:1356798920
Name:GELLER, MARC B (PA-C)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:B
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 1:1601 E SPRAGUE ST
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542-5260
Mailing Address - Country:US
Mailing Address - Phone:956-378-9290
Mailing Address - Fax:
Practice Address - Street 1:1601 E SPRAGUE ST
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542-5260
Practice Address - Country:US
Practice Address - Phone:956-378-9290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60664735363AM0700X
CAPA53648363AM0700X
TXPA10648363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical