Provider Demographics
NPI:1356875736
Name:FOSSUM, MARION ARTHUR (MD)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:ARTHUR
Last Name:FOSSUM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 S RITCHEY RD
Mailing Address - Street 2:
Mailing Address - City:MEDICAL LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99022-8792
Mailing Address - Country:US
Mailing Address - Phone:509-590-8766
Mailing Address - Fax:
Practice Address - Street 1:1717 S RITCHEY RD
Practice Address - Street 2:
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022-8792
Practice Address - Country:US
Practice Address - Phone:509-590-8766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA612549012084E0001X, 2084N0400X, 2084N0600X
FLME1673702084N0400X
NC2024-006102084N0400X
IL036.1693542084N0400X
IN01092935A2084N0400X
MS338012084N0400X
VA01012814482084N0400X
NJ25MA122604002084N0400X
NV262432084N0400X
ORMD2207842084N0400X
WI83574-202084N0400X
MO20240121042084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology