Basic Information
| Provider Information | |||||||||
| NPI: | 1003478033 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCGRATH | ||||||||
| FirstName: | MARK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1026 NE 65TH ST UNIT 216 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981156666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062517075 | ||||||||
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| Practice Location | |||||||||
| Address1: | 819 S 13TH ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982744112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608146230 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2019 | ||||||||
| LastUpdateDate: | 06/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.