Healthcare Provider Details

I. General information

NPI: 1609840131
Provider Name (Legal Business Name): PETER T. GELESKIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 01/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 BRIARVILLE RD BLDG B
MADISON TN
37115-5141
US

IV. Provider business mailing address

1210 BRIARVILLE RD BLDG B
MADISON TN
37115-5141
US

V. Phone/Fax

Practice location:
  • Phone: 615-860-0704
  • Fax: 615-860-8235
Mailing address:
  • Phone: 615-860-0704
  • Fax: 615-860-8235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD 33838
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: