Marilyn Ann Gandolph, PHYSICIAN ASSISTANT

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

3015 Issued in CO

Practice address

325 W S Boulder Rd Ste 101
Louisville, CO 80027-1130

Phone

(720) 519-1596

Fax

(720) 542-9408

NPI assigned

Apr 26, 2006

Last updated

Mar 17, 2018By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Paul Mackell MD PC

  • Family Medicine Physician
  • Lafayette, CO
  • NPI 1639358518
  NPD

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1154388148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 W S BOULDER RD STE 101",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800271130",
            "telephone_number": "720-519-1596",
            "fax_number": "720-542-9408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 W S BOULDER RD STE 101",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800271130",
            "telephone_number": "720-519-1596",
            "fax_number": "720-542-9408"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 East Simpson St.",
            "address_2": "Suite 101",
            "address_purpose": "LOCATION",
            "city": "LaFayette",
            "state": "CO",
            "postal_code": "80026",
            "country_code": "US",
            "telephone_number": "720-519-1596",
            "fax_number": "720-542-9408",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GANDOLPH",
        "first_name": "MARILYN",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-26",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "3015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andy Scott Gage, PT
• Anthony V Gagnor, PT, DPT
• Christina S Gamba, MD
• Shaylin S Gandhi, PA-C
• Jamie Gandolph, MA
• Tracy Gano, LCSW
• Victor Noe Garcia
• Allison Garvin, RN
• Alison Bernard Garza, LCSW
• Patricia Ann Gatto-Walden, PH.D.

• Medical Physician Assistant in Louisville, CO
• Providers in Louisville, CO by specialty
• Medical Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.