Healthcare Provider Details

I. General information

NPI: 1205279585
Provider Name (Legal Business Name): MARLA MCKNIGHT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST. PAUL'S HOSPITAL 1081 BURRARD STREET
VANCOUVER BRITISH COLUMBIA
V6Z1Y6
CA

IV. Provider business mailing address

771 MONTROYAL BLVD
NORTH VANCOUVER BRITISH COLUMBIA
V7R 2G4
CA

V. Phone/Fax

Practice location:
  • Phone: 604-682-2344
  • Fax:
Mailing address:
  • Phone: 604-990-9884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25968
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: