Provider Demographics
NPI:1952409773
Name:MAYR, NINA A (MD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:A
Last Name:MAYR
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:DEPARTMENT OF RADIATION ONCOLOGY
Mailing Address - Street 2:1959 NE PACIFIC STREET
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-6043
Mailing Address - Country:US
Mailing Address - Phone:206-598-4110
Mailing Address - Fax:206-598-3498
Practice Address - Street 1:DEPARTMENT OF RADIATION ONCOLOGY
Practice Address - Street 2:1959 NE PACIFIC STREET
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6043
Practice Address - Country:US
Practice Address - Phone:206-598-4110
Practice Address - Fax:206-598-3498
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD603674482085R0001X
OH350852842085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1952409773Medicaid
OH2547337Medicaid
F04414Medicare UPIN