Provider Demographics
NPI:1902198278
Name:MECKLING, KRISTOPHER T (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:T
Last Name:MECKLING
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 1:3005 112TH AVE NE
Mailing Address - Street 2:#210
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8015
Mailing Address - Country:US
Mailing Address - Phone:425-455-2015
Mailing Address - Fax:425-822-8890
Practice Address - Street 1:1035 116TH AVE NE
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4604
Practice Address - Country:US
Practice Address - Phone:425-646-5825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60492379207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology