MEDICARE: MARIA LUISA DY MD

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	251K00000X	Public Health or Welfare Agency	MD00043265	WA

General Provider Information

NPI Number	:	1508259979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA LUISA DY MD

Provider Business Mailing Address
First Line	:	PO BOX 13901
Second Line	:
City	:	SEATAC
State	:	WA
Zip	:	98198-1091
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2425 S 200TH ST
Second Line	:
City	:	SEATAC
State	:	WA
Zip	:	98198-5202
Country	:	US
Telephone Number	:	206-870-5739
Fax Number	:

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

Provider Enumeration Date	:	03/10/2015
Last Update Date	:	03/10/2015

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Directions to “ MARIA LUISA DY MD” Practice Location

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