Provider Demographics
NPI:1922085646
Name:POTAMPA, W MARK (MD)
Entity Type:Individual
Prefix:
First Name:W
Middle Name:MARK
Last Name:POTAMPA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WHITTON
Other - Middle Name:M
Other - Last Name:POTAMPA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1101 MADISON ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1306
Mailing Address - Country:US
Mailing Address - Phone:206-215-2004
Mailing Address - Fax:206-215-2055
Practice Address - Street 1:11919 NE 128TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7204
Practice Address - Country:US
Practice Address - Phone:425-821-6655
Practice Address - Fax:425-821-8836
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023322207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180021811OtherRAILROAD MEDICARE
WA0071123OtherLABOR & INDUSTRIES
WA8307290Medicaid
PO3997OtherREGENCE HEALTHCARE
E72748Medicare UPIN
WA8872932Medicare PIN