Provider Demographics
NPI:1144340472
Name:GELLER, DAVID M
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:GELLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-7040
Mailing Address - Fax:757-446-7049
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-7040
Practice Address - Fax:757-446-7049
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234879207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherCORVEL/CORCARE
VAPAROtherAETNA
VAPAROtherVIRGINIA HEALTH NETWORK
VA-022OtherTRICARE/CHAMPUS
VAPAROtherVIRGINIA PREMIER HEALTH
VA2170203OtherMAMSI
NC5907920Medicaid
VAPAROtherMULTIPLAN
NC07920OtherNC BC/BS
VA1144340472Medicaid
VA307839OtherANTHEM
VA10023991OtherOHP/SHP
VA0145495OtherCIGNA
VAPAROtherUSA MANAGED CARE
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VAPAROtherAETNA
VA014911E30Medicare PIN