Provider Demographics
NPI:1396832200
Name:DEVDATTA GABALE, M.D.
Entity Type:Organization
Organization Name:DEVDATTA GABALE, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEVDATTA
Authorized Official - Middle Name:
Authorized Official - Last Name:GABALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-750-0100
Mailing Address - Street 1:1205 LANGHORNE NEWTOWN RD
Mailing Address - Street 2:SUITE 304A
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1219
Mailing Address - Country:US
Mailing Address - Phone:215-750-0100
Mailing Address - Fax:215-750-0148
Practice Address - Street 1:1205 LANGHORNE NEWTOWN RD
Practice Address - Street 2:SUITE 304A
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1219
Practice Address - Country:US
Practice Address - Phone:215-750-0100
Practice Address - Fax:215-750-0148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052620L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2115137OtherAETNA
PA0717811000OtherINDEPENDENCE BLUE CROSS
PA0014814170005Medicaid
PA052279OtherHIGHMARK BLUE SHIELD
PA26205OtherHEALTH PARTNERS
PA0148141703OtherAMERICHOICE
PA1036664OtherKEYSTONE MERCY
PA052279Medicare ID - Type Unspecified
PA0014814170005Medicaid