Provider Demographics
NPI:1912120114
Name:GABRIELE, MARY E (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:GABRIELE
Suffix:
Gender:F
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:PO BOX 876
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-0037
Mailing Address - Country:US
Mailing Address - Phone:541-337-0156
Mailing Address - Fax:888-346-6225
Practice Address - Street 1:1275 IVY ST UNIT 4
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:OR
Practice Address - Zip Code:97448-2011
Practice Address - Country:US
Practice Address - Phone:541-649-1450
Practice Address - Fax:888-346-6225
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD28280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR279279Medicaid
OR279279Medicaid