Provider Demographics
NPI:1578545356
Name:MARXEN, VICTORIA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:LYNN
Last Name:MARXEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:425-899-3292
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:11521 NE 128TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4317
Practice Address - Country:US
Practice Address - Phone:425-899-6800
Practice Address - Fax:425-899-6808
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3660MAOtherBLUE SHIELD
WA172985OtherLABOR & INDUSTRIES
WA8310112Medicaid
WAP00156908OtherMEDICARE RAILROAD
WA172985OtherLABOR & INDUSTRIES
WAE57772Medicare UPIN