Provider Demographics
NPI:1386802007
Name:MARK G. OCHENRIDER, PLLC
Entity type:Organization
Organization Name:MARK G. OCHENRIDER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:OCHENRIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-821-4848
Mailing Address - Street 1:11903 NE 128TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7209
Mailing Address - Country:US
Mailing Address - Phone:425-821-4848
Mailing Address - Fax:425-821-4847
Practice Address - Street 1:11903 NE 128TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7209
Practice Address - Country:US
Practice Address - Phone:425-821-4848
Practice Address - Fax:425-821-4847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00048527207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1125020Medicaid