Provider Demographics
NPI:1164460358
Name:KOENIG, MARC G SR (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:G
Last Name:KOENIG
Suffix:SR
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 1:19020 33RD AVE W
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4746
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W
Practice Address - Street 2:SUITE 210
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4746
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1374
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD603208432085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA308619OtherLNI PROVIDER ID
WA2023776Medicaid
G04434Medicare UPIN
WAG8915732Medicare PIN
WAG8915733Medicare PIN
WAP01147432Medicare PIN
WA2023776Medicaid
WAG8915731Medicare PIN
WAG8915730Medicare PIN
WAG8915730Medicare PIN
WAG8915731Medicare PIN
WAG8915729Medicare PIN
G04434Medicare UPIN