Provider Demographics
NPI:1710042080
Name:MAGDALENO, MARK EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:MAGDALENO
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 1:1534 N 128TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-7700
Mailing Address - Country:US
Mailing Address - Phone:206-234-5166
Mailing Address - Fax:
Practice Address - Street 1:4634 E MARGINAL WAY S
Practice Address - Street 2:#E120
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-2398
Practice Address - Country:US
Practice Address - Phone:206-763-0474
Practice Address - Fax:206-763-0844
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044035208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics