Provider Demographics
NPI:1295868222
Name:GERACI, GASPERE CARMELO (MD)
Entity Type:Individual
Prefix:DR
First Name:GASPERE
Middle Name:CARMELO
Last Name:GERACI
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 275
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-0275
Mailing Address - Country:US
Mailing Address - Phone:717-728-7699
Mailing Address - Fax:717-728-4472
Practice Address - Street 1:4910 RITTER RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-4891
Practice Address - Country:US
Practice Address - Phone:717-728-7699
Practice Address - Fax:717-728-4472
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025264E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AG-1140300OtherDEA #
AG-1140300OtherDEA #
PA426891Medicare ID - Type Unspecified