Provider Demographics
NPI:1598741092
Name:GELIGA, PEDRO L (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:L
Last Name:GELIGA
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 492330
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-2330
Mailing Address - Country:US
Mailing Address - Phone:352-787-7611
Mailing Address - Fax:352-787-7216
Practice Address - Street 1:601 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7311
Practice Address - Country:US
Practice Address - Phone:352-787-7611
Practice Address - Fax:352-787-7216
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00533152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12198BSOtherBLUE SHIELD
E31496Medicare UPIN
40582Medicare ID - Type Unspecified