Provider Demographics
NPI:1164458212
Name:KIRSCHNER, MARC ALAN (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:ALAN
Last Name:KIRSCHNER
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 1:1536 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:206-365-6771
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:206-365-6771
Practice Address - Fax:206-365-2980
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000347672084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1100734Medicaid
WA1100734Medicaid
WAG8808311Medicare ID - Type Unspecified