DR. MARC D PELLICCIARO (NPI# 1962575951) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962575951 |
| Entity Type | Individual |
| Full Name | DR. MARC D PELLICCIARO |
| Credential | M.D. |
| Practice Address |
12729 Northup Way Ste 6 Bellevue WA 98005-1935 |
| Practice Telephone | 4254671000 |
| Practice Fax Number | 4254670100 |
| Mailing Telephone | 4254671000 |
| Mailing Fax Number | 4254670100 |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2019-04-17 |
| NPI Deactivation Date | 05/09/2018 |
| NPI Reactivation Date | 2018-05-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
MD 00036813 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | MD2652 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 12320 Ne 8th St Ste 201b, Bellevue, WA 980053198 | 4254671000 | 4254670100 |
| Street Address |
12729 NORTHUP WAY STE 6 |
| City | BELLEVUE |
| State | WA |
| Zip Code | 98005-1935 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003346594 | Magnolia Psychiatry, LLC | Psychiatry & Neurology | 12729 Northup Way Ste 6, Bellevue, WA 98005-1935 | 2017-06-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679194161 | Move Well, Be Well Pllc | Clinic/Center | 11900 Ne 1st Street, Suite 3106, Bellevue, WA 98005 | 2020-05-06 |
| 1649899410 | Wen-fang Ku | Acupuncturist | 13555 Bel-red Rd, Suite 110, Bellevue, WA 98005 | 2020-04-13 |
| 1558901801 | Janelle Morris | Behavior Technician | 12729 Northup Way, Suite 9, Bellevue, WA 98005 | 2020-01-14 |
| 1912467234 | Amanda Gallardo | Behavior Technician | 13333 Bel Rd Suite 100, Bellevue, WA 98005 | 2019-03-22 |
| 1639637903 | Oxana I Varvaryuk | Massage Therapist | 606 120th Ave Ne, Suite D104, Bellevue, WA 98005 | 2019-03-06 |
| 1609346246 | Bhavjit Kaur Mangat | Optometrist | 1808 Richards Rd Suite 110, Bellevue, WA 98005 | 2018-11-27 |
| 1386138907 | Amanda Frances Ellis | Dietitian, Registered | 915 118th Ave Se, Attention Alecia Johnson, Ret Physica, Suite 110, Bellevue, WA 98005 | 2018-06-18 |
| 1093227654 | Jinda Chaijinda | Naturopath | 13353 Bel-red Road Suite A105, Bellevue, WA 98005 | 2017-11-03 |
| 1962927038 | Laura Jo Zuker Olsen | Optometrist | 13401 Bel-red Rd Ne, Suite A4 - Bellevue Vision Clinic, Bellevue, WA 98005 | 2017-08-09 |
| 1336678697 | Yong Huang | Massage Therapist | 12505 Bel-red Road, Suite 188, Bellevue, WA 98005 | 2017-06-08 |
| Find all providers in zip 98005 | ||||
| Taxonomy Code | 2084A0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Addiction Medicine |
| A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |
| Notes: Source: American Osteopathic Board of Neurology and Psychiatry, 2007 [1/1/2008: definition added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821188764 | Steven M Juergens | Psychiatry & Neurology | 11201 Se 8th St Ste 105, Bellevue, WA 98004-6420 | 2006-10-13 |
| 1679517684 | Telecare Mental Health Services of Nebraska, Inc | Psychiatry & Neurology | 2231 Lincoln Rd, Bellevue, NE 68005-3907 | 2006-06-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811155773 | Raghuram B Bhat | Psychiatry & Neurology | 417 Ne 2nd Ave Ste 205, Camas, WA 98607 | 2008-05-28 |
| 1487863999 | Phyllis Jo Henderson | Psychiatry & Neurology | 418 S 44th Ave, Yakima, WA 98908-3303 | 2007-05-21 |
| 1205956265 | Kevin Richard Wandler | Psychiatry & Neurology | 888 S Hillhurst Rd, Ridgefield, WA 98642-9063 | 2007-03-30 |
| 1457410961 | Frederick A Montgomery Md Inc Ps | Psychiatry & Neurology | 215 So 11th # D, Yakima, WA 98902 | 2006-12-08 |
| 1225666951 | Radiant Path Psychiatry Pllc | Psychiatry & Neurology | 330 King St Ste 5, Wenatchee, WA 98801-2857 | 2020-03-30 |
| 1184101073 | Luke Rosen, Do, Pllc | Psychiatry & Neurology | 2501 Ne 134th St Ste 203, Vancouver, WA 98686-3026 | 2018-07-24 |
| 1386883726 | Seema Basnett | Psychiatry & Neurology | 10001 17th Pl S, Lower Level, Seattle, WA 98168-1615 | 2009-02-09 |
| 1093921660 | Allison Evans Gullo | Psychiatry & Neurology | 6926 Ne Fourth Plain Blvd, Vancouver, WA 98661-7369 | 2007-05-14 |
| 1497880355 | John R Moran | Psychiatry & Neurology | 12101 Ambaum Blvd Sw, Burien, WA 98146-2651 | 2007-02-22 |
| 1124120761 | Shamim Hashemi Nejad | Psychiatry & Neurology | 1221 Madison St, Seattle, WA 98104-3588 | 2006-09-03 |
| Find all providers with the same taxonomy | ||||
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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.