Provider Demographics
NPI:1205990033
Name:GABRIEL, ANDREW H (DO)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:H
Last Name:GABRIEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W GRAND AVE STE 4400
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-7538
Mailing Address - Country:US
Mailing Address - Phone:937-278-8244
Mailing Address - Fax:937-274-8982
Practice Address - Street 1:7740 WASHINGTON VILLAGE DR STE 110
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3994
Practice Address - Country:US
Practice Address - Phone:937-278-8244
Practice Address - Fax:937-522-9790
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003827208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0701584Medicaid
OH1720129OtherUHC
OH000000005821OtherBS & ANTHEM
OHGA0615711Medicare PIN
OHH301661Medicare PIN
OH1720129OtherUHC
OHAZ5918Medicare UPIN