Gamal H Eltabbakh, M.D.
Individual provider Active NPI Gynecologic Oncology Physician · South Burlington, VT
NPI 1467448787 · NPPES record last updated May 23, 2013
Key facts
- NPI
- 1467448787
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Gynecologic Oncology Physician 207VX0201X
- License
- 0420009610 (VT)
- Practice address
- 1060 Hinesburg Rd
Suite 301
South Burlington, VT 05403-7612 - Phone
- (802) 859-9500
- Fax
- (802) 859-9944
- NPI assigned
- Sep 22, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Quality
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060217000632 | NY | Practitioner - Obstetrics/Gynecology |
5294649125 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1994931 | NY | MD | Gynecologic Oncology Physician |
| 0420009610 | VT | MD | Gynecologic Oncology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Champlain Valley Physicians Hospital Medical Center | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | 0420009610 | VT | |
| Gynecology Physician | 207VG0400X | 1994931 | NY | |
| Gynecologic Oncology Physician | 207VX0201X | 0420009610 | VT | Yes |
| Gynecologic Oncology Physician | 207VX0201X | 1994931 | NY |
Addresses
Primary practice location
1060 Hinesburg Rd
Suite 301
South Burlington, VT 05403-7612
Mailing address
1060 Hinesburg Rd
Suite 301
South Burlington, VT 05403-7612
Phone (802) 859-9500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01760585 | Medicaid | NY | |
| OVN1692 | Medicaid | VT |
Other providers in South Burlington, VT
- Jessica Lynn Edwards
- Jiana Eisenberg
- Elcm Manor South Management LLC
- Elevate Health Chiropractic LLC
- Jennifer May Elsinger
- Georgia D Eltabbakh
- Elvira Zulkic, MSW. LLC
- Jill Lorraine Entis
- Erik Willis, Ma, LLC
- Lisa Martin Eriksson
All providers in South Burlington, VT · Gynecologic Oncology Physician in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 23, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.