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NPI Code Detail

MEDICARE: MARK ROBERT WARD SUDP

MEDICARE: MARK ROBERT WARD SUDP
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
1101YA0400XAddiction (Substance Use Disorder) CounselorRC00053877WA

General Provider Information

NPI Number : 1568528743
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK ROBERT WARD SUDP
Provider Business Mailing Address
First Line : 2 MIDNIGHT CT
Second Line :
City : BELLINGHAM
State : WA
Zip : 98229-7808
Country : US
Telephone Number : 360-595-3972
Fax Number :
Provider Business Practice Location Address
First Line : 515 LAKEWAY DR
Second Line :
City : BELLINGHAM
State : WA
Zip : 98225-5233
Country : US
Telephone Number : 360-676-2187
Fax Number : 360-676-2162
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2006
Last Update Date : 04/28/2021

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