Healthcare Provider Details

I. General information

NPI: 1871588087
Provider Name (Legal Business Name): PHILIP A GELACEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 07/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 FORD ST SUITE 2A
FORD CITY PA
16226-1268
US

IV. Provider business mailing address

313 FORD ST SUITE 2A
FORD CITY PA
16226-1268
US

V. Phone/Fax

Practice location:
  • Phone: 724-763-7144
  • Fax: 724-763-7161
Mailing address:
  • Phone: 724-763-7144
  • Fax: 724-763-7161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD020788E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: