Provider Demographics
NPI:1689621559
Name:PASNICK, MARYKAY (MD)
Entity Type:Individual
Prefix:
First Name:MARYKAY
Middle Name:
Last Name:PASNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S 336TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6328
Mailing Address - Country:US
Mailing Address - Phone:253-838-6180
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:1211 24TH ST
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2557
Practice Address - Country:US
Practice Address - Phone:360-299-1300
Practice Address - Fax:360-299-1312
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018020207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3075PAOtherBSWA
WA0209142OtherLIWA
WA8130148Medicaid
WA0209142OtherLIWA
WAE74841Medicare UPIN
WAG8861954Medicare PIN