Healthcare Provider Details

I. General information

NPI: 1912989062
Provider Name (Legal Business Name): MARC MAUNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 KLICKITAT WAY SW #205 PUGET SOUND INSTITUTE OF PATHOLOGY
SEATTLE WA
98134
US

IV. Provider business mailing address

PO BOX 34245 PSIP
SEATTLE WA
98124-1245
US

V. Phone/Fax

Practice location:
  • Phone: 206-622-7747
  • Fax: 206-467-1470
Mailing address:
  • Phone: 206-622-7747
  • Fax: 206-467-1470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberMD00021445
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD00021445
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: