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General NPI Number Information
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NPI Number | 1942293907
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Entity Type | Individual
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Provider Name | GARY MARMOLYA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/25/2005
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 18697 BAGLEY RD RADIOLOGY DEPARTMENT
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City | CLEVELAND
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State | OH
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Zip | 44130-3417
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Country | US
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Telephone | 440-816-8000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 567
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City | CHAGRIN FALLS
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State | OH
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Zip | 44022-0567
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Country | US
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Telephone | 216-464-5160
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Fax | 216-464-5982
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 35041562
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License Number State | OH
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