Healthcare Provider Details

I. General information

NPI: 1730169822
Provider Name (Legal Business Name): GARY C GELESH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 COLEGATE DR EMERGENCY DEPARTMENT
MARIETTA OH
45750-1323
US

IV. Provider business mailing address

550 HIGHLANDS DR
AKRON OH
44333-2679
US

V. Phone/Fax

Practice location:
  • Phone: 740-568-2000
  • Fax:
Mailing address:
  • Phone: 330-666-4820
  • Fax: 330-666-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34006231
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number000003
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: