Individual
MARK A DERAMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1806 W LINCOLN AVE, YAKIMA, WA 98902-2473
(509) 452-4520
(509) 452-5224
Mailing address
501 S 5TH AVE, YAKIMA, WA 98902-3550
(509) 494-6700
(509) 573-6275
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00039153
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0183345
LABOR & INDUSTRIES
WA
05
—
8405524
—
WA
01
—
P00181860
RAILROAD MEDICARE
WA
Enumeration date
07/19/2005
Last updated
10/07/2020
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