Provider Demographics
NPI:1477670495
Name:KLINE, MARK DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DOUGLAS
Last Name:KLINE
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 1:44930 MORAND DRIVE PMB 114
Mailing Address - Street 2:
Mailing Address - City:CASPAR
Mailing Address - State:CA
Mailing Address - Zip Code:95420-0147
Mailing Address - Country:US
Mailing Address - Phone:707-225-4744
Mailing Address - Fax:
Practice Address - Street 1:2319 N 45TH ST STE 209
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6978
Practice Address - Country:US
Practice Address - Phone:206-468-9654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000432342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC03967FMedicaid
CAFHC03967FMedicaid
CA551813Medicare ID - Type Unspecified