Individual
DR. GARY MARMOLYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
18697 BAGLEY RD, RADIOLOGY DEPARTMENT, CLEVELAND, OH 44130-3417
(440) 816-8000
Mailing address
PO BOX 567, CHAGRIN FALLS, OH 44022-0567
(216) 464-5160
(216) 464-5982
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
35041562
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221317
UNISON
OH
01
—
00000516221
ANTHEM
OH
05
—
0750763
—
OH
01
—
363808
WELLCARE
OH
01
—
4261908
AETNA
OH
01
—
733052
BUCKEYE
OH
01
—
P00412503
RAILROAD MEDICARE
OH
Enumeration date
08/25/2005
Last updated
07/29/2008
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