Healthcare Provider Details

I. General information

NPI: 1740268325
Provider Name (Legal Business Name): MARK D. PAPENHAUSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 NORTON AVE SUITE 201
EVERETT WA
98201-4290
US

IV. Provider business mailing address

728 134TH ST SW SUITE 120
EVERETT WA
98204-5322
US

V. Phone/Fax

Practice location:
  • Phone: 425-258-4624
  • Fax:
Mailing address:
  • Phone: 425-297-6200
  • Fax: 425-297-6250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD00045479
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD00045479
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD00045479
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: