Provider Demographics
NPI:1104118637
Name:GABLE, MARY SUSAN (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:SUSAN
Last Name:GABLE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:21206 SARAHILLS DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-4869
Mailing Address - Country:US
Mailing Address - Phone:408-867-0195
Mailing Address - Fax:408-877-1701
Practice Address - Street 1:529 GROTH CT
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9424
Practice Address - Country:US
Practice Address - Phone:408-309-6370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105881207R00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine