Katelyn Hagstrom Marilao, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

V9615 Issued in TX

Practice address

4881 Sugar Maple Dr
Wpafb, OH 45433-5529

Phone

(937) 257-0770

NPI assigned

Apr 13, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Katelyn Anne Hagstrom Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784678400000",
    "number": "1013603810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4881 SUGAR MAPLE DR",
            "city": "WPAFB",
            "state": "OH",
            "postal_code": "454335529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4881 SUGAR MAPLE DR",
            "city": "WPAFB",
            "state": "OH",
            "postal_code": "454335529",
            "telephone_number": "937-257-0770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARILAO",
        "first_name": "KATELYN",
        "middle_name": "HAGSTROM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-13",
        "last_updated": "2026-07-22",
        "certification_date": "2026-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "V9615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATELYN",
            "last_name": "HAGSTROM",
            "middle_name": "ANNE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Stephen Gene Long, P.A.
• David Lucius, PHARM D.RPH
• John P Lynch, MD, MPH, FAAFP, CPE
• Joshua Tyler Lynn, IDMT
• Kegan Alec Main, DO
• Nickolay Peter Markov, MD
• Stephen Brooks Martin, IDMT
• Alexis Faith Matheney, MOT, OTR/L
• Gary Steven Mayne Jr., DDS, MS
• Courtney Tai McCormick, PHARMD

• Emergency Medicine Physician in Wpafb, OH
• Providers in Wpafb, OH by specialty
• Emergency Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.