Provider Demographics
NPI:1245218171
Name:MAYHLE, MARK DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DONALD
Last Name:MAYHLE
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 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W STE 210
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4748
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-123092085R0202X
WAMD000297252085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8254898Medicaid
ID1245218171Medicaid
WA201567OtherL&I PROVIDER NUMBER
WA139238OtherL&I PROVIDER NUMBER
WA0377942OtherL&I PROVIDER NUMBER
WA139237OtherL&I PROVIDER NUMBER
WAG8895086Medicare PIN
WAG8920756Medicare PIN
WAGAB15060Medicare PIN
WA139237OtherL&I PROVIDER NUMBER
WA139238OtherL&I PROVIDER NUMBER
WAE84449Medicare UPIN
WAGAB15061Medicare PIN
WA8862857Medicare PIN
WAG8857918Medicare PIN
WA201567OtherL&I PROVIDER NUMBER