Provider Demographics
NPI:1063410512
Name:MAGINN, PATRICK C (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:C
Last Name:MAGINN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 9TH AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2464
Mailing Address - Country:US
Mailing Address - Phone:360-425-3720
Mailing Address - Fax:360-425-0090
Practice Address - Street 1:625 9TH AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2464
Practice Address - Country:US
Practice Address - Phone:360-425-3720
Practice Address - Fax:360-425-0090
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2007-10-22
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
WAMD0000193Z5208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR115655OtherMEDICARE
WA1819002Medicaid
A16070Medicare UPIN
WAGAB34515Medicare PIN