DR. MARK DEDOMENICO (NPI# 1760737654) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760737654 |
| Entity Type | Individual |
| Full Name | DR. MARK DEDOMENICO |
| Practice Address |
4455 148th Ave Ne Bellevue WA 98007-3120 |
| Practice Telephone | 4258675175 |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2012-07-17 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208D00000X | General Practice | 29548 | MO | Allopathic & Osteopathic Physicians |
| N | 208D00000X | General Practice | 27531 | CA | Allopathic & Osteopathic Physicians |
| Y | 208D00000X | General Practice | MD00011381 | WA | Allopathic & Osteopathic Physicians |
| Street Address |
4455 148TH AVE NE |
| City | BELLEVUE |
| State | WA |
| Zip Code | 98007-3120 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831137892 | Pierce Edward Scranton Jr. | Orthopaedic Surgery | 4455 148th Ave Ne, Bellevue, WA 98007-3120 | 2006-06-03 |
| 1982238465 | Professional Recreation Organization, Inc. | Clinic/Center | 4455 148th Ave Ne, Bellevue, WA 98007-3120 | 2020-02-24 |
| 1821634924 | Lily Irene Nealon | Physical Therapist | 4455 148th Ave Ne, Bellevue, WA 98007-3120 | 2019-11-23 |
| 1841840436 | Galina Borisovna Riabinina | Physical Therapist | 4455 148th Ave Ne, Bellevue, WA 98007-3120 | 2019-09-16 |
| 1023663416 | Micah Jeremiah Armbrust | Physical Therapist | 4455 148th Ave Ne, Bellevue, WA 98007-3120 | 2019-08-03 |
| 1144708819 | Professional Recreation Organization, Inc. | Clinic/Center | 4455 148th Ave Ne, Bellevue, WA 98007-3120 | 2018-08-03 |
| 1245726538 | Professional Recreation Organization, Inc. | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4455 148th Ave Ne, Bellevue, WA 98007-3120 | 2018-07-10 |
| 1508352881 | Professional Recreation Organization, Inc. | Obstetrics & Gynecology | 4455 148th Ave Ne, Bellevue, WA 98007-3120 | 2018-07-10 |
| 1871080945 | Madeline Erin Kilpatrick | Social Worker | 4455 148th Ave Ne, Bellevue, WA 98007-3120 | 2018-04-15 |
| 1710496674 | Threasa Andrys | Naturopath | 4455 148th Ave Ne, Bellevue, WA 98007-3120 | 2017-09-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982204947 | Janet Delgado | Interpreter | 3000 Landerholm Cir Se, Bellevue, WA 98007 | 2020-10-29 |
| 1467092643 | Stephanie Schaal | Counselor | 15395 Se 30th Place Ste 120, Bellevue, WA 98007 | 2020-01-15 |
| 1740824358 | Alison Elizabeth Campbell | Massage Therapist | 14575 Ne Bel Red Rd Ste 100, Bellevue, WA 98007 | 2019-11-06 |
| 1275188021 | Pacific Coast Health Care, Pllc | Internal Medicine | Mission Healthcare At Bellevue, 2424 156th Avenue Ne, Bellevue, WA 98007 | 2019-08-08 |
| 1417475054 | Terasak Roeksbutr | Dietitian, Registered | 109 146th Ave Se, Bellevue, WA 98007 | 2017-09-04 |
| 1083130934 | Po-lung Wu | Acupuncturist | 693 156th Ave Se, Bellevue, WA 98007 | 2017-08-22 |
| 1689117319 | Audrey K. Tatt D.d.s. P.l.l.c. | Dentist | 15419 Ne 20th St. #206, Bellevue, WA 98007 | 2016-11-29 |
| 1952751836 | Mona Ebrahimi | Student in an Organized Health Care Education/Training Program | 14270 Ne 21st, Rainbow Creek, Bellevue, WA 98007 | 2016-06-21 |
| 1578939302 | Walgreen | Student in an Organized Health Care Education/Training Program | 15220 156th Ne, Bellevue, WA 98007 | 2015-08-17 |
| 1750767406 | Anar Veliyev | Physical Therapist | 14828 Ne 12th St, Bellevue, WA 98007 | 2015-08-05 |
| Find all providers in zip 98007 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407134034 | Shane Michael Thomas | General Practice | 4524 173rd Ave Se, Bellevue, WA 98006-6524 | 2011-08-01 |
| 1821309147 | Li Zhai | General Practice | 1406 140th Pl Ne Ste 100, Bellevue, WA 98007-3941 | 2010-07-01 |
| 1275656076 | Daria Marie Davidson | General Practice | 1400 112th Ave Se Ste 100q, Bellevue, WA 98004-6901 | 2007-04-08 |
| 1144885245 | Ashley Anne Triboulet | General Practice | 10655 Ne 4th St Ste 101, Bellevue, WA 98004-5022 | 2019-05-03 |
| 1861918518 | Professional Recreation Organization, Inc. | General Practice | 4455 148th Ave Ne, Bellevue, WA 98007-3120 | 2017-08-15 |
| 1831444306 | Barry Weiss | General Practice | 10655 Ne 4th St, Ste 310, Bellevue, WA 98004-5035 | 2012-07-19 |
| 1649551037 | Sage Medical Group | General Practice | 12600 Se 38th St, Suite 130, Bellevue, WA 98006-6105 | 2011-08-30 |
| 1396031100 | Michael Woo, Nd, L.ac. Inc. | General Practice | 2320 130th Ave Ne, Suite 120, Bellevue, WA 98005-1752 | 2011-06-21 |
| 1841420593 | Patrick Phan, M.d., P.s. | General Practice | 2902 112th Ave Se, Bellevue, WA 98004-7528 | 2009-07-15 |
| 1255512885 | Joseph Walter Upton IIi | General Practice | 4455 148th Ave Ne, Bellevue, WA 98007-3120 | 2007-11-26 |
| Find all providers in BELLEVUE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.