Healthcare Provider Details

I. General information

NPI: 1669619813
Provider Name (Legal Business Name): MARIKO MARIUM YABE-GILL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIUM GILL M.D.

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210
US

IV. Provider business mailing address

251 SALINA MEADOWS PKWY STE 100
SYRACUSE NY
13212-4516
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-6323
  • Fax: 315-464-6322
Mailing address:
  • Phone: 315-464-2000
  • Fax: 315-464-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number310214
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: