Provider Demographics
NPI:1972618817
Name:GABRIEL, TIMOTEO R (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTEO
Middle Name:R
Last Name:GABRIEL
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 1:2060 LIMESTONE RD
Mailing Address - Street 2:STE 203
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5500
Mailing Address - Country:US
Mailing Address - Phone:302-998-0300
Mailing Address - Fax:302-998-0300
Practice Address - Street 1:1941 LIMESTONE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5400
Practice Address - Country:US
Practice Address - Phone:302-998-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0002149207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DECN 2339OtherPALMETTO GBA
DE104723F82Medicare PIN