Provider Demographics
NPI:1619976545
Name:GABELMAN, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:GABELMAN
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 1:23250 MERCANTILE RD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5928
Mailing Address - Country:US
Mailing Address - Phone:216-292-0600
Mailing Address - Fax:216-292-0609
Practice Address - Street 1:23250 MERCANTILE RD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5928
Practice Address - Country:US
Practice Address - Phone:216-292-0600
Practice Address - Fax:216-292-0609
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35030434G174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH09-00089OtherUNITED HEALTH CARE
OH000000126902OtherANTHEM
OH200009567OtherMEDICARE RR
OH09-00089OtherUNITED HEALTH CARE
OH09-00089OtherUNITED HEALTH CARE
OH0399363Medicare ID - Type Unspecified