Basic Information
| Provider Information | |||||||||
| NPI: | 1013091834 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 84088 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981248488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254545281 | ||||||||
| FaxNumber: | 4259905261 | ||||||||
| Practice Location | |||||||||
| Address1: | 1407 116TH AVE NE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980043819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254545046 | ||||||||
| FaxNumber: | 4259905261 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 11/03/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 00030846 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00403553 | 01 | WA | RAILROAD MEDICARE PIN | OTHER |