Healthcare Provider Details

I. General information

NPI: 1649341983
Provider Name (Legal Business Name): GAMALIEL P BATALLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7337 CARITAS CIRLE NW
MASSILLON OH
44646
US

IV. Provider business mailing address

PO BOX 951103
CLEVELAND OH
44193-0008
US

V. Phone/Fax

Practice location:
  • Phone: 330-830-6110
  • Fax:
Mailing address:
  • Phone: 330-489-1074
  • Fax: 330-489-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD427683
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number51050
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number35.096379
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD437683
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: