MEDICARE: DR. MARK MICHAEL SAPIRSTEIN 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	174400000X	Specialist	MD00015702	WA

General Provider Information

NPI Number	:	1659485167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK MICHAEL SAPIRSTEIN M.D.

Provider Business Mailing Address
First Line	:	1106 DOUGLAS ST
Second Line	:	SUITE D
City	:	LONGVIEW
State	:	WA
Zip	:	98632-2497
Country	:	US
Telephone Number	:	360-423-0088
Fax Number	:	360-414-7251

Provider Business Practice Location Address
First Line	:	1106 DOUGLAS ST
Second Line	:	SUITE D
City	:	LONGVIEW
State	:	WA
Zip	:	98632-2497
Country	:	US
Telephone Number	:	360-423-0088
Fax Number	:	360-414-7251

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/09/2007

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