Provider Demographics
NPI:1326155136
Name:EMANUEL, MARGAUX RAELYNN (MD)
Entity Type:Individual
Prefix:
First Name:MARGAUX
Middle Name:RAELYNN
Last Name:EMANUEL
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 1:2208 NW MARKET ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4030
Mailing Address - Country:US
Mailing Address - Phone:206-320-3335
Mailing Address - Fax:
Practice Address - Street 1:2208 NW MARKET ST
Practice Address - Street 2:SUITE 410
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4030
Practice Address - Country:US
Practice Address - Phone:206-320-3335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60080769207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0252117OtherL&I
WA1326155136Medicaid
WA1326155136Medicaid