Provider Demographics
NPI:1659323749
Name:MARQUARDT, CAROLYN A (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:A
Last Name:MARQUARDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:A
Other - Last Name:RUAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1750 112TH AVE NE
Mailing Address - Street 2:STE. D-258
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3752
Mailing Address - Country:US
Mailing Address - Phone:425-451-2272
Mailing Address - Fax:425-451-1052
Practice Address - Street 1:1750 112TH AVE NE
Practice Address - Street 2:STE. D-258
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3752
Practice Address - Country:US
Practice Address - Phone:425-451-2272
Practice Address - Fax:425-451-1052
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000036797208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation