Provider Demographics
NPI:1013056787
Name:ROY, MADHURINA (MD)
Entity type:Individual
Prefix:DR
First Name:MADHURINA
Middle Name:
Last Name:ROY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9505 19TH AVE SE
Mailing Address - Street 2:STE 100
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3843
Mailing Address - Country:US
Mailing Address - Phone:425-225-6721
Mailing Address - Fax:425-225-6725
Practice Address - Street 1:9505 19TH AVE SE
Practice Address - Street 2:STE 100
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3843
Practice Address - Country:US
Practice Address - Phone:425-225-6721
Practice Address - Fax:425-225-6725
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00037174207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8801638Medicare PIN