MEDICARE: DR. MARK L ADRIANCE 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	207Q00000X	Family Medicine Physician	MD00015299	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	080147963	OTHER	WA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	7852AD	OTHER	WA	REGENCE BLUESHIELD
3	8752AD	OTHER	WA	REGENCE BLUESHIELD
4	3252AD	OTHER	WA	REGENCE BLUESHIELD
5	4852AD	OTHER	WA	REGENCE BLUESHIELD
6	8932695	OTHER	WA	L&I CRIME VICTIM
7	0718AD	OTHER	WA	REGENCE BLUESHIELD
8	9782AD	OTHER	WA	REGENCE BLUESHIELD
10	4324AD	OTHER	WA	REGENCE BLUESHIELD
11	0130089	OTHER	WA	L&I REGULAR
12	423898-034	OTHER	WA	GROUP HEATLH COOPERATIVE

General Provider Information

NPI Number	:	1598723942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK L ADRIANCE M.D.

Provider Business Mailing Address
First Line	:	709 W ORCHARD DR
Second Line	:	SUITE 4
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-1766
Country	:	US
Telephone Number	:	360-318-8800
Fax Number	:	360-318-1085

Provider Business Practice Location Address
First Line	:	709 W ORCHARD DR
Second Line	:	SUITE 4
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-1766
Country	:	US
Telephone Number	:	360-318-8800
Fax Number	:	360-318-1085

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/24/2012

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