Provider Demographics
NPI:1689802266
Name:MEAD, VICTORIA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:MARIE
Last Name:MEAD
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 1:4508 AUBURN WAY N
Mailing Address - Street 2:SUITE C
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-1381
Mailing Address - Country:US
Mailing Address - Phone:253-737-5764
Mailing Address - Fax:
Practice Address - Street 1:4508 AUBURN WAY N
Practice Address - Street 2:SUITE C
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-1381
Practice Address - Country:US
Practice Address - Phone:253-737-5764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60364559207QG0300X
PAMT194481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine