Healthcare Provider Details

I. General information

NPI: 1447478938
Provider Name (Legal Business Name): MARSHA ALEXIS CHENOWETH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 114TH AVE SE STE 180
BELLEVUE WA
98004-6955
US

IV. Provider business mailing address

1601 114TH AVE SE STE 180
BELLEVUE WA
98004-6955
US

V. Phone/Fax

Practice location:
  • Phone: 425-451-1134
  • Fax: 425-451-8501
Mailing address:
  • Phone: 425-451-1134
  • Fax: 425-451-8501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD 60476301
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD 60476301
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD 60476301
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: