MEDICARE: MARK WILLIAM HAMBLIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD00028139	WA

General Provider Information

NPI Number	:	1245335363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK WILLIAM HAMBLIN M.D.

Provider Business Mailing Address
First Line	:	1660 S COLUMBIAN WAY
Second Line	:	GRECC 182B
City	:	SEATTLE
State	:	WA
Zip	:	98108-1532
Country	:	US
Telephone Number	:	206-764-2298
Fax Number	:	206-764-2569

Provider Business Practice Location Address
First Line	:	4020 E MADISON ST STE 325
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98112-3150
Country	:	US
Telephone Number	:	206-715-4862
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	06/12/2020

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