Provider Demographics
NPI:1225002967
Name:GRAZKO, MARYBETH ARVIDSON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARYBETH
Middle Name:ARVIDSON
Last Name:GRAZKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E JEFFERSON ST STE 205
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5644
Mailing Address - Country:US
Mailing Address - Phone:206-386-2700
Mailing Address - Fax:206-386-2703
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVENUE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431
Practice Address - Country:US
Practice Address - Phone:253-968-2252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC353512084N0400X
WAMD000420882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology