Provider Demographics
NPI:1649414301
Name:KOENEN, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:KOENEN
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 1:601 UNION ST
Mailing Address - Street 2:SUITE 1704
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2341
Mailing Address - Country:US
Mailing Address - Phone:206-623-1949
Mailing Address - Fax:
Practice Address - Street 1:601 UNION ST
Practice Address - Street 2:SUITE 1704
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2341
Practice Address - Country:US
Practice Address - Phone:206-623-1949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-26
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000413482084P0800X, 2084F0202X
CAA1067952084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry