Provider Demographics
NPI:1063474435
Name:ELES, GUSTAV R (DO)
Entity Type:Individual
Prefix:
First Name:GUSTAV
Middle Name:R
Last Name:ELES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 BEAVER GRADE RD STE B2
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2766
Mailing Address - Country:US
Mailing Address - Phone:412-264-9500
Mailing Address - Fax:412-264-8999
Practice Address - Street 1:995 BEAVER GRADE ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-2766
Practice Address - Country:US
Practice Address - Phone:412-264-9500
Practice Address - Fax:412-264-8999
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005112L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810017484Medicaid
PA1079909Medicaid
NC1605UOtherBCBSNC
OH2195413Medicaid
PA0010799090027Medicaid
NC1605UOtherBCBSNC
PA525689Medicare ID - Type Unspecified
PA1079909Medicaid
OH2195413Medicaid
PA0010799090027Medicaid