Provider Demographics
NPI:1689926693
Name:WASHINGTON, MARC T (RPA-C)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:T
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 E. PRATER WAY, SUITE 207
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434
Mailing Address - Country:US
Mailing Address - Phone:775-356-9393
Mailing Address - Fax:775-356-5590
Practice Address - Street 1:3802 MEADOWS LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-3112
Practice Address - Country:US
Practice Address - Phone:702-313-8446
Practice Address - Fax:702-221-8446
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015798363A00000X
NVPA1728363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1689926693Medicaid
NY02993882Medicaid
NYJ400081182Medicare PIN