MEDICARE: MARIETTA BABAYEV M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	20710	WV
2	208100000X	Physical Medicine & Rehabilitation Physician	35.081228	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	250013237	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	001720906	OTHER	MOUNTAIN STATE BCBS

General Provider Information

NPI Number	:	1033161666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIETTA BABAYEV M.D.

Provider Business Mailing Address
First Line	:	90 JACKSON PIKE
Second Line	:
City	:	GALLIPOLIS
State	:	OH
Zip	:	45631-1560
Country	:	US
Telephone Number	:	304-744-2300
Fax Number	:	304-744-8195

Provider Business Practice Location Address
First Line	:	313 MACCORKLE AVE SW
Second Line	:
City	:	SOUTH CHARLESTON
State	:	WV
Zip	:	25303-1263
Country	:	US
Telephone Number	:	304-746-3706
Fax Number	:	304-744-8195

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	09/03/2014

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Directions to “ MARIETTA BABAYEV M.D.” Practice Location

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