1396832200 NPI number — DEVDATTA GABALE, M.D.

Table of content: (NPI 1396832200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396832200 NPI number — DEVDATTA GABALE, M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEVDATTA GABALE, M.D.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396832200
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1205 LANGHORNE NEWTOWN RD
Provider Second Line Business Mailing Address:
SUITE 304A
Provider Business Mailing Address City Name:
LANGHORNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19047-1219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-750-0100
Provider Business Mailing Address Fax Number:
215-750-0148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1205 LANGHORNE NEWTOWN RD
Provider Second Line Business Practice Location Address:
SUITE 304A
Provider Business Practice Location Address City Name:
LANGHORNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19047-1219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-750-0100
Provider Business Practice Location Address Fax Number:
215-750-0148
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GABALE
Authorized Official First Name:
DEVDATTA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
215-750-0100

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  MD052620L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2115137 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0717811000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0014814170005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 052279 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 26205 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0148141703 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1036664 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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