Gabriel Alexis Revelo

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

License

29224 Issued in MD

Practice address

1605 Roland Heights Ave
Baltimore, MD 21211-1685

Phone

(443) 653-2725

NPI assigned

Jun 4, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690934400000",
    "number": "1881333003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 BENTGRASS DR",
            "city": "ABERDEEN",
            "state": "MD",
            "postal_code": "210013948",
            "telephone_number": "443-653-2725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 ROLAND HEIGHTS AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212111685",
            "telephone_number": "443-653-2725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVELO",
        "first_name": "GABRIEL",
        "middle_name": "ALEXIS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-04",
        "last_updated": "2023-08-02",
        "certification_date": "2023-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "MD",
            "license": "29224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.