Provider Demographics
NPI:1205876661
Name:GABOVITCH, EDWARD R (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:R
Last Name:GABOVITCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-962-4836
Mailing Address - Fax:317-962-8646
Practice Address - Street 1:1801 N SENATE BLVD
Practice Address - Street 2:SUITE 315
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1228
Practice Address - Country:US
Practice Address - Phone:317-962-3500
Practice Address - Fax:317-962-2735
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01018037207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN675920AMedicare PIN
IND95650Medicare UPIN