Basic Information
| Provider Information | |||||||||
| NPI: | 1295754448 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DECOURTEN-MYERS | ||||||||
| FirstName: | GABRIELLE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136182848 | ||||||||
| FaxNumber: | 5136182849 | ||||||||
| Practice Location | |||||||||
| Address1: | 231 ALBERT SABIN WAY | ||||||||
| Address2: | DEPARTMENT OF PATHOLOGY | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452670001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135584500 | ||||||||
| FaxNumber: | 5135582289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZN0500X | 35-04-8558-D | OH | Y | Allopathic & Osteopathic Physicians | Pathology | Neuropathology |
ID Information
| ID | Type | State | Issuer | Description | 0655092 | 01 | OH | AETNA | OTHER | 64861990 | 05 | KY | MEDICAID | 000000009221 | 01 | OH | ANTHEM | OTHER | 0539073 | 05 | OH | MEDICAID |