Provider Demographics
NPI:1447404090
Name:MARION, MARIA PAVLOVA (LMP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:PAVLOVA
Last Name:MARION
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15623 1ST AVE S
Mailing Address - Street 2:SUITE C
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1292
Mailing Address - Country:US
Mailing Address - Phone:206-444-6320
Mailing Address - Fax:
Practice Address - Street 1:1419 3RD AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2105
Practice Address - Country:US
Practice Address - Phone:425-442-6810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023472171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor