Individual
MARISSA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11521 NE 128TH ST STE 100, KIRKLAND, WA 98034
(425) 899-6800
(425) 899-6818
Mailing address
11521 NE 128TH ST STE 100, KIRKLAND, WA 98034-4317
(425) 899-6800
(425) 899-6818
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
MD60371542
WA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
MD60571983
WA
Other
Enumeration date
03/21/2013
Last updated
07/17/2019
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