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General NPI Number Information
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NPI Number | 1497781595
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Entity Type | Individual
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Provider Name | SUSAN MARY GELETKA M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 08/04/2013
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Provider Practice Location Address
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Address Line | 9275 W CALLA RD
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City | CANFIELD
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State | OH
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Zip | 44406-9459
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Country | US
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Telephone | 330-533-2775
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Fax |
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Provider Business Mailing Address
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Address Line | 9275 W CALLA RD
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City | CANFIELD
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State | OH
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Zip | 44406-9459
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Country | US
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Telephone | 330-533-2775
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD031019E
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 35.049584
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 01047749A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 4301071351
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 10836
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License Number State | NH
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Taxonomy #6
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036-104891
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License Number State | IL
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Taxonomy #7
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 168054-1
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License Number State | NY
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