Provider Demographics
NPI:1346204039
Name:KATABAY, ADIL OMAR (MD)
Entity Type:Individual
Prefix:
First Name:ADIL
Middle Name:OMAR
Last Name:KATABAY
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 1:1065 DELAWARE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302
Mailing Address - Country:US
Mailing Address - Phone:740-387-7246
Mailing Address - Fax:740-387-7244
Practice Address - Street 1:1065 DELAWARE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302
Practice Address - Country:US
Practice Address - Phone:740-387-7246
Practice Address - Fax:740-387-7244
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080847207L00000X, 207LP2900X
246RM2200X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2318414Medicaid
H60307Medicare UPIN
OH2318414Medicaid