Provider Demographics
NPI:1851754139
Name:PROKOP, GABRIELLE MARIE (MD)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:MARIE
Last Name:PROKOP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:MARIE
Other - Last Name:DICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:416 COLEGATE DR BLDG 3
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-9549
Mailing Address - Country:US
Mailing Address - Phone:740-568-4814
Mailing Address - Fax:740-374-3165
Practice Address - Street 1:320 E 8TH ST STE 142
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3382
Practice Address - Country:US
Practice Address - Phone:740-373-4111
Practice Address - Fax:740-373-4860
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-03
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.138663207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty