Provider Demographics
NPI:1134549272
Name:THAYER, MARY KATHRYN (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN
Last Name:THAYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:510 8TH AVE NE STE 320
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-5436
Mailing Address - Country:US
Mailing Address - Phone:425-455-3600
Mailing Address - Fax:425-455-3920
Practice Address - Street 1:3101 NORTHUP WAY STE 201
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1449
Practice Address - Country:US
Practice Address - Phone:425-455-3600
Practice Address - Fax:425-455-3920
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60773007207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2037339Medicaid