Provider Demographics
NPI:1104036623
Name:GABRIEL SELLA INC
Entity Type:Organization
Organization Name:GABRIEL SELLA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-633-4485
Mailing Address - Street 1:92 N 4TH ST STE 12
Mailing Address - Street 2:
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935-1600
Mailing Address - Country:US
Mailing Address - Phone:740-633-4485
Mailing Address - Fax:740-633-4141
Practice Address - Street 1:92 N 4TH ST STE 12
Practice Address - Street 2:
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-1600
Practice Address - Country:US
Practice Address - Phone:740-633-4485
Practice Address - Fax:740-633-4141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH51365261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0699463Medicaid
WV0052234000Medicaid
WV0052234000Medicaid
OH9932841Medicare PIN