Healthcare Provider Details

I. General information

NPI: 1114364122
Provider Name (Legal Business Name): MAYLIN J PADAYATTY MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 05/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 4TH AVE
PASCO WA
99301-5257
US

IV. Provider business mailing address

4003 S IRBY ST
KENNEWICK WA
99337-2455
US

V. Phone/Fax

Practice location:
  • Phone: 509-547-7704
  • Fax:
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD00043799
License Number StateWA

VIII. Authorized Official

Name: LORI LABRECQUE
Title or Position: ACCOUNTS MANAGER
Credential:
Phone: 702-453-3799