Provider Demographics
NPI:1114964038
Name:GESLIEN, G. ERIC (MD)
Entity Type:Individual
Prefix:
First Name:G.
Middle Name:ERIC
Last Name:GESLIEN
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:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-0790
Mailing Address - Country:US
Mailing Address - Phone:603-770-6225
Mailing Address - Fax:
Practice Address - Street 1:100 HITCHCOCK WAY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-4125
Practice Address - Country:US
Practice Address - Phone:603-629-1877
Practice Address - Fax:603-695-2856
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH74972085R0202X
CAG268672085R0202X
FLME860912085R0202X
MA2166222085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80000547Medicaid
NH80000547Medicaid
NHNH9222Medicare ID - Type Unspecified