Provider Demographics
NPI:1659485167
Name:SAPIRSTEIN, MARK MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:MICHAEL
Last Name:SAPIRSTEIN
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 1:1106 DOUGLAS ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2497
Mailing Address - Country:US
Mailing Address - Phone:360-423-0088
Mailing Address - Fax:360-414-7251
Practice Address - Street 1:1106 DOUGLAS ST
Practice Address - Street 2:SUITE D
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2497
Practice Address - Country:US
Practice Address - Phone:360-423-0088
Practice Address - Fax:360-414-7251
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015702174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist