MEDICARE: DR. RAVINDER SINGH MAROK 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	2084P0800X	Psychiatry Physician	MD60541870	WA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	2084P0804X	Child & Adolescent Psychiatry Physician	MD60541870	WA

General Provider Information

NPI Number	:	1871728378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAVINDER SINGH MAROK M.D

Provider Business Mailing Address
First Line	:	753 N 35TH ST STE 311
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-8873
Country	:	US
Telephone Number	:	206-501-4342
Fax Number	:

Provider Business Practice Location Address
First Line	:	753 N 35TH ST STE 311
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-8873
Country	:	US
Telephone Number	:	206-501-4342
Fax Number	:

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

Provider Enumeration Date	:	05/27/2009
Last Update Date	:	05/10/2023

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