1528087582 NPI number — MARITA BARBARA ACHESON M.D.

Table of content: MARITA BARBARA ACHESON M.D. (NPI 1528087582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528087582 NPI number — MARITA BARBARA ACHESON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ACHESON
Provider First Name:
MARITA
Provider Middle Name:
BARBARA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528087582
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 24905
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98124-0905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-846-5527
Provider Business Mailing Address Fax Number:
607-324-2369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1135 116TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004-4623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-688-5985
Provider Business Practice Location Address Fax Number:
425-467-3685
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  MD00021389 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1066161 . This is a "FIRST HEALTH/CCN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2893654 . This is a "AETNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 010383910 . This is a "TRICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7499117 . This is a "CIGNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8107146 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8937367 . This is a "L & I CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 170470 . This is a "L & I WORKERS COMP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 4316AC . This is a "REGENCE BLUESHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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