Basic Information
| Provider Information | |||||||||
| NPI: | 1376552653 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CIERI | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1608 S J ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532747503 | ||||||||
| FaxNumber: | 2532747993 | ||||||||
| Practice Location | |||||||||
| Address1: | 1608 S J ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532747503 | ||||||||
| FaxNumber: | 2532747993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 02/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD00035155 | WA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 370016840 | 01 | WA | MEDICARE RAILROAD | OTHER | G139121 | 01 | WA | STATE L&I | OTHER | 1043922 | 05 | WA | MEDICAID |