Provider Demographics
NPI:1649341983
Name:BATALLA, GAMALIEL P (MD)
Entity type:Individual
Prefix:
First Name:GAMALIEL
Middle Name:P
Last Name:BATALLA
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:PO BOX 951103
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0008
Mailing Address - Country:US
Mailing Address - Phone:330-489-1074
Mailing Address - Fax:330-489-1281
Practice Address - Street 1:7337 CARITAS CIRLE NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646
Practice Address - Country:US
Practice Address - Phone:330-830-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427683207L00000X
MN51050208VP0014X
OH35.096379207LP2900X
PAMD437683208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1812107000Medicaid
H60489Medicare UPIN
PA162383NCMMedicare PIN
WV1812107000Medicaid
WV4081313Medicare PIN