Provider Demographics
NPI:1609840131
Name:GELESKIE, PETER T (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:T
Last Name:GELESKIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 BRIARVILLE RD
Mailing Address - Street 2:BLDG B
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5141
Mailing Address - Country:US
Mailing Address - Phone:615-860-0704
Mailing Address - Fax:615-860-8235
Practice Address - Street 1:1210 BRIARVILLE RD
Practice Address - Street 2:BLDG B
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-5141
Practice Address - Country:US
Practice Address - Phone:615-860-0704
Practice Address - Fax:615-860-8235
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 33838207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG16294Medicare UPIN
TN3851266Medicare ID - Type Unspecified