Provider Demographics
NPI:1366490674
Name:STARKEBAUM, MARY KATHRYN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHRYN
Last Name:STARKEBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6800 E GREENLAKE WAY N
Mailing Address - Street 2:#200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5491
Mailing Address - Country:US
Mailing Address - Phone:206-524-5656
Mailing Address - Fax:206-524-2841
Practice Address - Street 1:6800 E GREENLAKE WAY N
Practice Address - Street 2:#200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5491
Practice Address - Country:US
Practice Address - Phone:206-524-5656
Practice Address - Fax:206-524-2841
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017604207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1316801Medicaid
WAA05700Medicare UPIN
WAAB15292Medicare ID - Type Unspecified