Healthcare Provider Details

I. General information

NPI: 1134549272
Provider Name (Legal Business Name): MARY KATHRYN THAYER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 NORTHUP WAY STE 201
BELLEVUE WA
98004-1449
US

IV. Provider business mailing address

510 8TH AVE NE STE 320
ISSAQUAH WA
98029-5436
US

V. Phone/Fax

Practice location:
  • Phone: 425-455-3600
  • Fax: 425-455-3920
Mailing address:
  • Phone: 425-455-3600
  • Fax: 425-455-3920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD60773007
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMD60773007
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: