Healthcare Provider Details

I. General information

NPI: 1497781595
Provider Name (Legal Business Name): SUSAN MARY GELETKA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 08/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9275 W CALLA RD
CANFIELD OH
44406-9459
US

IV. Provider business mailing address

9275 W CALLA RD
CANFIELD OH
44406-9459
US

V. Phone/Fax

Practice location:
  • Phone: 330-533-2775
  • Fax:
Mailing address:
  • Phone: 330-533-2775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD031019E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.049584
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01047749A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301071351
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number10836
License Number StateNH
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036-104891
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number168054-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: