Provider Demographics
NPI:1982960282
Name:MAGWENE, ELENA MALAIKA (MD)
Entity type:Individual
Prefix:MS
First Name:ELENA
Middle Name:MALAIKA
Last Name:MAGWENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:MALAIKA
Other - Last Name:MCCULLOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1959 NE PACIFIC STREET
Mailing Address - Street 2:BOX 356560, RM BB1644
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-6560
Mailing Address - Country:US
Mailing Address - Phone:206-543-3750
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:BOX 356560, RM BB1644
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6560
Practice Address - Country:US
Practice Address - Phone:206-543-3750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD604899332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry