Magnolia Psychiatry, LLC

Primary specialty

Addiction Psychiatry PhysicianTaxonomy code 2084P0802X

License

MD00036813 Issued in WA

Legal business name

MAGNOLIA PSYCHIATRY, LLC

Practice address

12729 Northup Way Ste 6
Bellevue, WA 98005-1935

Phone

(425) 467-1000

Fax

(425) 467-0100

NPI assigned

Jun 15, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marc David Pellicciaro, MDNPI 1962575951

Title

Psychiatrist

Phone

(425) 467-1000

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marc D Pellicciaro, M.D.

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Bellevue, WA
  • NPI 1962575951
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555459200000",
    "number": "1003346594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7239",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980081239",
            "telephone_number": "425-467-1000",
            "fax_number": "425-467-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12729 NORTHUP WAY STE 6",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980051935",
            "telephone_number": "425-467-1000",
            "fax_number": "425-467-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA PSYCHIATRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-15",
        "last_updated": "2019-04-17",
        "status": "A",
        "authorized_official_last_name": "PELLICCIARO",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PSYCHIATRIST",
        "authorized_official_telephone_number": "425-467-1000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "WA",
            "license": "MD00036813",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON STATE MEDICAL LICENSE",
            "identifier": "MD00036813",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paul T. Maginnis, PA-C
• Patricia Magnani, LICSW
• Hannah Magness, DNP
• Magnolia Homecare Services LLC
• Magnolia Mental Health Washington LLC
• Magnolia Transportation Services
• Erik Arthur Magnusson, MD
• Karlene Mah, MSC.OT
• Megha Mahale, OT
• Jaclyn Mahlstede, ARNP

• Addiction Psychiatry Physician in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Addiction Psychiatry Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.