Provider Demographics
NPI:1154592194
Name:MARC ALAN KIRSCHNER, MD, PS
Entity type:Organization
Organization Name:MARC ALAN KIRSCHNER, MD, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KIRSCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-365-3223
Mailing Address - Street 1:1536 N 115TH ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8400
Mailing Address - Country:US
Mailing Address - Phone:206-365-3223
Mailing Address - Fax:206-365-2980
Practice Address - Street 1:1536 N 115TH ST
Practice Address - Street 2:SUITE 330
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8400
Practice Address - Country:US
Practice Address - Phone:206-365-3223
Practice Address - Fax:206-365-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034767174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1100734Medicaid
WA1100734Medicaid
WAG8808311Medicare PIN