MEDICARE: DR. MARY J SHROFF 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	207R00000X	Internal Medicine Physician	MD00034855	WA

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

General Provider Information

NPI Number	:	1760443493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY J SHROFF MD

Provider Business Mailing Address
First Line	:	PO BOX 2810
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-2810
Country	:	US
Telephone Number	:	425-831-0777
Fax Number	:	425-831-0505

Provider Business Practice Location Address
First Line	:	209 MAIN AVE S
Second Line	:	SUITE 115
City	:	NORTH BEND
State	:	WA
Zip	:	98045-8139
Country	:	US
Telephone Number	:	425-831-0777
Fax Number	:	425-831-0505

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	07/08/2007

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