Provider Demographics
NPI:1083632913
Name:MARS, STACIE L (MD)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:L
Last Name:MARS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11811 NE 128TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7200
Mailing Address - Country:US
Mailing Address - Phone:425-821-3472
Mailing Address - Fax:425-820-4115
Practice Address - Street 1:1310 116TH AVE NE
Practice Address - Street 2:SUITE E
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3817
Practice Address - Country:US
Practice Address - Phone:425-250-1145
Practice Address - Fax:425-823-6028
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD000370172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8263188Medicaid
WA8263188Medicaid
WAH26011Medicare UPIN