Provider Demographics
NPI:1194884098
Name:ZELLER, DAVID ALLEN JR (MPAS PA-C, APA, CCHP)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLEN
Last Name:ZELLER
Suffix:JR
Gender:M
Credentials:MPAS PA-C, APA, CCHP
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 1084
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33509-1084
Mailing Address - Country:US
Mailing Address - Phone:253-677-7655
Mailing Address - Fax:
Practice Address - Street 1:2480 LLEWELLYN AVE STE 5800
Practice Address - Street 2:
Practice Address - City:FORT MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755-5129
Practice Address - Country:US
Practice Address - Phone:253-677-7655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC07116363A00000X
WAPA60277854363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPA60277854OtherPHYSICIAN ASSISTANT LICENSE, WASHINGTON STATE
MDC07116OtherPHYSICIAN ASSISTANT LICENSE, MARYLAND