Basic Information
| Provider Information | |||||||||
| NPI: | 1730169822 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GELESH | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 HIGHLANDS DR | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443332679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306664820 | ||||||||
| FaxNumber: | 3306664820 | ||||||||
| Practice Location | |||||||||
| Address1: | 1106 COLEGATE DR | ||||||||
| Address2: | EMERGENCY DEPARTMENT | ||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457501323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405682000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 09/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 34006231 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 000003 | LA | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1621412 | 05 | LA | MEDICAID | 3810009945 | 05 | WV | MEDICAID | 0570501 | 05 | OH | MEDICAID |