Provider Demographics
NPI: | 1427139757 |
---|---|
Name: | GABRIEL, HOSNY S (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | HOSNY |
Middle Name: | S |
Last Name: | GABRIEL |
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: | 6225 N STATE HIGHWAY 161 STE 200 |
Mailing Address - Street 2: | |
Mailing Address - City: | IRVING |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75038-2241 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 214-967-0496 |
Mailing Address - Fax: | 214-987-9344 |
Practice Address - Street 1: | 1340 HAL GREER BLVD |
Practice Address - Street 2: | |
Practice Address - City: | HUNTINGTON |
Practice Address - State: | WV |
Practice Address - Zip Code: | 25701-3800 |
Practice Address - Country: | US |
Practice Address - Phone: | 205-322-1808 |
Practice Address - Fax: | 205-322-1851 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-10-17 |
Last Update Date: | 2018-03-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WV | 14490 | 207L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WV | 001720970 | Other | BCBS |
OH | 0775451 | Medicaid | |
OH | 1001645 | Other | WORKERS' COMP |
P00231032 | Other | PALMETTO GBA-RR MEDICARE | |
WV | 0057980000 | Medicaid | |
KY | 64697915 | Medicaid | |
WV | 0057980000 | Medicaid |