Provider Demographics
NPI:1932399243
Name:GELLER, AMALIA ANTIGONI (MD)
Entity type:Individual
Prefix:
First Name:AMALIA
Middle Name:ANTIGONI
Last Name:GELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMALIA
Other - Middle Name:A
Other - Last Name:LOUPIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8601 W EMERALD ST STE 176
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8297
Mailing Address - Country:US
Mailing Address - Phone:208-793-7006
Mailing Address - Fax:
Practice Address - Street 1:8601 W EMERALD ST STE 176
Practice Address - Street 2:8601 W EMERALD ST STE 176
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8297
Practice Address - Country:US
Practice Address - Phone:208-793-7006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMC-16062084N0400X
TXM57212084N0400X
NV171142084N0400X
WAMD610194452084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD61019445OtherLICENSE
WAFG8907656OtherDEA
TX318029YK00Medicare PIN
TX191621507OtherCSHCN