Provider Demographics
NPI:1033161666
Name:BABAYEV, MARIETTA (MD)
Entity Type:Individual
Prefix:
First Name:MARIETTA
Middle Name:
Last Name:BABAYEV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:304-744-2300
Mailing Address - Fax:304-744-8195
Practice Address - Street 1:313 MACCORKLE AVE SW
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1263
Practice Address - Country:US
Practice Address - Phone:304-746-3706
Practice Address - Fax:304-744-8195
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20710208100000X
OH35.081228208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000185283OtherUNISON MEDICAID
250013237OtherRR MEDICARE
OH2306972OtherMOLINA MEDICAID
WV1808136000Medicaid
OH310917085158OtherCARESOURCE MEDICAID
001720906OtherMOUNTAIN STATE BCBS
OH310917085158OtherCARESOURCE MEDICAID
OH2306972OtherMOLINA MEDICAID
250013237OtherRR MEDICARE