Provider Demographics
NPI:1528087582
Name:ACHESON, MARITA BARBARA (MD)
Entity type:Individual
Prefix:
First Name:MARITA
Middle Name:BARBARA
Last Name:ACHESON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24905
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0905
Mailing Address - Country:US
Mailing Address - Phone:888-846-5527
Mailing Address - Fax:607-324-2369
Practice Address - Street 1:1135 116TH AVE NE
Practice Address - Street 2:SUITE 250
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4623
Practice Address - Country:US
Practice Address - Phone:425-688-5985
Practice Address - Fax:425-467-3685
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000213892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1066161OtherFIRST HEALTH/CCN
WA2893654OtherAETNA
WA010383910OtherTRICARE
WA7499117OtherCIGNA
WA8107146Medicaid
WA8937367OtherL & I CRIME VICTIMS
WA170470OtherL & I WORKERS COMP
WA4316ACOtherREGENCE BLUESHIELD
WA4316ACOtherREGENCE BLUESHIELD
WAAB32141Medicare PIN
WA300133026Medicare PIN