Individual
DR. MARTIN NICHOLAS BOMALASKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 NE MOTHER JOSEPH PL STE 100, VANCOUVER, WA 98664-3292
(360) 514-3142
(360) 514-6809
Mailing address
1115 SE 164TH AVE DEPT 358, VANCOUVER, WA 98683-8004
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
MD189020
OR
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD60739177
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508109349
—
WA
01
—
8967115
MEDICARE PIN
WA
Enumeration date
03/29/2013
Last updated
01/24/2020
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