Provider Demographics
NPI:1538257860
Name:MARSH, PETER K (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:K
Last Name:MARSH
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 1:1624 SOUTH I STREET
Mailing Address - Street 2:SUITE 305
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5093
Mailing Address - Country:US
Mailing Address - Phone:253-428-8700
Mailing Address - Fax:253-383-3376
Practice Address - Street 1:1624 SOUTH I STREET
Practice Address - Street 2:SUITE 405
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5094
Practice Address - Country:US
Practice Address - Phone:253-428-8700
Practice Address - Fax:253-627-0714
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019108207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAWAM250Medicaid
WAAB04771Medicare ID - Type UnspecifiedMEDICARE
WAWAM250Medicaid