Provider Demographics
NPI:1467642249
Name:EISSA, MARNA J (MD)
Entity Type:Individual
Prefix:
First Name:MARNA
Middle Name:J
Last Name:EISSA
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 1:645 W LAKE SAMMAMISH PKWY NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-4226
Mailing Address - Country:US
Mailing Address - Phone:504-782-0332
Mailing Address - Fax:425-590-9719
Practice Address - Street 1:1229 MADISON ST STE 1050
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3306
Practice Address - Country:US
Practice Address - Phone:206-215-2651
Practice Address - Fax:206-386-6913
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.2011532085R0202X
WAMD.601380742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1079456Medicaid