Provider Demographics
NPI:1992741946
Name:GABALE, DEVDATTA R (MD)
Entity type:Individual
Prefix:
First Name:DEVDATTA
Middle Name:R
Last Name:GABALE
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 1:2 CAPITAL WAY
Mailing Address - Street 2:SUITE 407
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-2521
Mailing Address - Country:US
Mailing Address - Phone:609-730-1966
Mailing Address - Fax:609-730-1166
Practice Address - Street 1:2 CAPITAL WAY
Practice Address - Street 2:SUITE 407
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2521
Practice Address - Country:US
Practice Address - Phone:609-730-1966
Practice Address - Fax:609-730-1166
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD052620L208800000X
NJ25MA06313100208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4577320OtherAETNA PROV ID
PA0717811000OtherINDEPENDENCE BLUE CROSS
PA0148141703OtherAMERICHOICE
PA052279OtherHIGHMARK BLUE SHIELD
PA340016351OtherRAILROAD MEDICARE
PA0014814170005Medicaid
PA1053544528OtherMEDICARE GROUP NPI
PA1992741946OtherMEDICARE NPI
PA0148141703OtherAMERICHOICE