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NPI Code Detail

MEDICARE: MARY ELLEN HARGRAVE M.D.

MEDICARE: MARY ELLEN HARGRAVE 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
12084P0800XPsychiatry PhysicianMD00043305WA

General Provider Information

NPI Number : 1578602777
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ELLEN HARGRAVE M.D.
Provider Business Mailing Address
First Line : 3200 SHOREWOOD DR
Second Line : #131
City : MERCER ISLAND
State : WA
Zip : 98040-6200
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 325 W GOWE ST
Second Line :
City : KENT
State : WA
Zip : 98032-5892
Country : US
Telephone Number : 253-833-7444
Fax Number : 253-735-1513
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2007
Last Update Date : 07/08/2007

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