Provider Demographics
NPI:1205947199
Name:SAINT CLAIR, MARY MARCELLE (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:MARCELLE
Last Name:SAINT CLAIR
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 1:161 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-6205
Mailing Address - Country:US
Mailing Address - Phone:206-328-8907
Mailing Address - Fax:206-323-5809
Practice Address - Street 1:8313 AURORA AVE NO
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103
Practice Address - Country:US
Practice Address - Phone:206-784-0737
Practice Address - Fax:206-784-0369
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8143372Medicaid
F02899Medicare UPIN
WA8804901Medicare PIN