Provider Demographics
NPI:1932146552
Name:SIENKO, MARK EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:SIENKO
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:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0146
Mailing Address - Country:US
Mailing Address - Phone:360-683-9895
Mailing Address - Fax:360-582-5614
Practice Address - Street 1:844 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3045
Practice Address - Country:US
Practice Address - Phone:360-683-9895
Practice Address - Fax:360-582-5614
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046621207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KAV04OtherBLUE CROSS OF IDAHO
210908OtherLABOR & INDUSTRIES
7951715OtherAETNA
WA8457376Medicaid
ID807543000Medicaid
ID000010157955OtherBLUE SHIELD OF IDAHO
7676SIOtherASURIS NW HEALTH
P00326346OtherRAILROAD MEDICARE
ID000010157955OtherBLUE SHIELD OF IDAHO
F30343Medicare UPIN