Provider Demographics
NPI:1487671814
Name:ABALLAY, ARIEL M (MD)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:M
Last Name:ABALLAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 LIBERTY AVE STE M02
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-578-1448
Mailing Address - Fax:412-605-6316
Practice Address - Street 1:4815 LIBERTY AVE STE M02
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-578-1448
Practice Address - Fax:412-605-6316
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428169208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101668885Medicaid
11622374OtherCAQH
WV3810008520Medicaid
PA102353YB7EMedicare PIN
PA101668885Medicaid