| Magnolia Psychiatry, Llc | |
|
12729 Northup Way Ste 6 Bellevue WA 98005-1935 | |
| (425) 467-1000 | |
| (425) 467-0100 |
| Full Name | Magnolia Psychiatry, Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Addiction Psychiatry |
| Location | 12729 Northup Way Ste 6, Bellevue, Washington |
| Authorized Official Name and Position | Marc David Pellicciaro (PSYCHIATRIST) |
| Authorized Official Contact | 4254671000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Psychiatry, Llc Po Box 7239 Bellevue WA 98008-1239 Ph: (425) 467-1000 | Magnolia Psychiatry, Llc 12729 Northup Way Ste 6 Bellevue WA 98005-1935 Ph: (425) 467-1000 |
| NPI Number | 1003346594 |
|---|---|
| Provider Enumeration Date | 06/15/2017 |
| Last Update Date | 04/17/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003346594 | NPI | - | NPPES |
| MD00036813 | Other | WA | WASHINGTON STATE MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0802X | Psychiatry & Neurology - Addiction Psychiatry | MD00036813 (Washington) | Primary |
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