Provider Demographics
NPI:1295754448
Name:DECOURTEN-MYERS, GABRIELLE (MD)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:DECOURTEN-MYERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2102
Mailing Address - Country:US
Mailing Address - Phone:513-618-2848
Mailing Address - Fax:513-618-2849
Practice Address - Street 1:231 ALBERT SABIN WAY
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-0001
Practice Address - Country:US
Practice Address - Phone:513-558-4500
Practice Address - Fax:513-558-2289
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-8558-D207ZN0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0655092OtherAETNA
KY64861990Medicaid
OH000000009221OtherANTHEM
OH0539073Medicaid
OHE57913Medicare UPIN
OH0655092OtherAETNA