Provider Demographics
NPI:1063696789
Name:GADZHIEV, MARAT (MD)
Entity type:Individual
Prefix:
First Name:MARAT
Middle Name:
Last Name:GADZHIEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 HARLOW RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-7124
Mailing Address - Country:US
Mailing Address - Phone:541-687-4900
Mailing Address - Fax:
Practice Address - Street 1:1007 HARLOW RD
Practice Address - Street 2:STE 210
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-7124
Practice Address - Country:US
Practice Address - Phone:541-687-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5591207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine