Provider Demographics
NPI:1497046841
Name:GILAT, EDAN (MD)
Entity type:Individual
Prefix:DR
First Name:EDAN
Middle Name:
Last Name:GILAT
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 1:1035 PROPRIETORS RD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3230
Mailing Address - Country:US
Mailing Address - Phone:614-785-1115
Mailing Address - Fax:
Practice Address - Street 1:1035 PROPRIETORS RD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3230
Practice Address - Country:US
Practice Address - Phone:614-785-1115
Practice Address - Fax:614-785-0095
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1263822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0132082Medicaid
OH0132082Medicaid