Provider Demographics
NPI:1942324157
Name:GABRIELSEN, S. CAMPBELL (MD)
Entity Type:Individual
Prefix:
First Name:S.
Middle Name:CAMPBELL
Last Name:GABRIELSEN
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 1:1185 N 1000 W
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-5282
Mailing Address - Country:US
Mailing Address - Phone:812-847-3381
Mailing Address - Fax:812-847-9496
Practice Address - Street 1:1043 N 1000 W
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-5281
Practice Address - Country:US
Practice Address - Phone:812-847-3381
Practice Address - Fax:812-847-9496
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039423A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100352430Medicaid
IN320690CMedicare ID - Type Unspecified
IN940020Medicare ID - Type UnspecifiedHOSPITAL PART B PROVIDER