Provider Demographics
NPI:1255373759
Name:GAGE, DEBORAH MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:MARIE
Last Name:GAGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:MARIE
Other - Last Name:BABCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3100 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2018
Mailing Address - Country:US
Mailing Address - Phone:410-360-4446
Mailing Address - Fax:410-360-4449
Practice Address - Street 1:3100 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2018
Practice Address - Country:US
Practice Address - Phone:410-360-4446
Practice Address - Fax:410-360-4449
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0066843208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD415156900Medicaid
PA0018578430004Medicaid
6782399OtherAETNA HMO
7472244OtherAETNA PPO
PA049191Medicare ID - Type Unspecified
OH2563417Medicare ID - Type Unspecified
PA0018578430004Medicaid