Provider Demographics
NPI:1851313753
Name:GAGE, MARILYN D (MD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:D
Last Name:GAGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3516 SURREY DR NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-3627
Mailing Address - Country:US
Mailing Address - Phone:360-456-2206
Mailing Address - Fax:
Practice Address - Street 1:3516 SURREY DR NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-3627
Practice Address - Country:US
Practice Address - Phone:360-456-2206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029195207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8134389Medicaid
WAA02353Medicare UPIN
WA8855707Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE