Provider Demographics
NPI:1003952862
Name:MARTI, LAURIE A (MD)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:MARTI
Suffix:
Gender:F
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 2307
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98083
Mailing Address - Country:US
Mailing Address - Phone:425-232-1965
Mailing Address - Fax:
Practice Address - Street 1:5400 CARILLON POINT
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033
Practice Address - Country:US
Practice Address - Phone:425-232-1965
Practice Address - Fax:425-463-4267
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040753174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H66827Medicare UPIN