Healthcare Provider Details

I. General information

NPI: 1376552653
Provider Name (Legal Business Name): MARTIN V CIERI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 S J ST FL 2
TACOMA WA
98405-4930
US

IV. Provider business mailing address

1608 S J ST FL 2
TACOMA WA
98405-4930
US

V. Phone/Fax

Practice location:
  • Phone: 253-274-7503
  • Fax: 253-274-7993
Mailing address:
  • Phone: 253-274-7503
  • Fax: 253-274-7993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00035155
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: