Provider Demographics
NPI:1710068879
Name:PEDICELLI, GABRIELE (MD)
Entity Type:Individual
Prefix:
First Name:GABRIELE
Middle Name:
Last Name:PEDICELLI
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 1:23625 COMMERCE PARK
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5845
Mailing Address - Country:US
Mailing Address - Phone:216-255-5725
Mailing Address - Fax:866-618-2917
Practice Address - Street 1:23625 COMMERCE PARK
Practice Address - Street 2:SUITE 204
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5845
Practice Address - Country:US
Practice Address - Phone:216-255-5725
Practice Address - Fax:866-618-2917
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0634592085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
300043195OtherRAILROAD MEDICARE
310851206015OtherMEDICAL MUTUAL OF OHIO
000000006781OtherANTHEM BC/BS
000000006781OtherANTHEM BC/BS-FEDERAL
OH0889454Medicaid
000000006781OtherANTHEM BC/BS
F34399Medicare UPIN
OHPE0721012Medicare PIN