Provider Demographics
NPI:1134143209
Name:SAULITIS, MARA (MD)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:SAULITIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARA
Other - Middle Name:
Other - Last Name:LIEBLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:945 HILDEBRAND LN NE STE 100
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2887
Practice Address - Country:US
Practice Address - Phone:206-991-2121
Practice Address - Fax:206-991-2151
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60386200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0VN2453Medicaid
WA1134143209Medicaid
MAG14995Medicare UPIN