MEDICARE: MARTHA G PANITCH MD PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD00030175	WA

General Provider Information

NPI Number	:	1083927008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA G PANITCH MD PHD

Provider Business Mailing Address
First Line	:	3834 NE 86TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-3729
Country	:	US
Telephone Number	:	206-524-0129
Fax Number	:	206-522-1482

Provider Business Practice Location Address
First Line	:	3834 NE 86TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-3729
Country	:	US
Telephone Number	:	206-524-0129
Fax Number	:	206-522-1482

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	08/23/2010

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