Maranatha Medical Clinic Inc P S

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

17917 Issued in WA

Legal business name

MARANATHA MEDICAL CLINIC INC P S

Practice address

17900 Talbot Rd S
#101
Renton, WA 98055-8212

Phone

(425) 235-9614

Fax

(425) 235-1060

NPI assigned

Nov 23, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Dan L Grav Es, MD

Title

President

Phone

(425) 235-9614

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1258934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505088000000",
    "number": "1205164639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17900 TALBOT RD S",
            "address_2": "#101",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980558212",
            "telephone_number": "425-235-9614",
            "fax_number": "425-235-1060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17900 TALBOT RD S",
            "address_2": "#101",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980558212",
            "telephone_number": "425-235-9614",
            "fax_number": "425-235-1060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARANATHA MEDICAL CLINIC INC P S",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-23",
        "last_updated": "2017-09-11",
        "status": "A",
        "authorized_official_last_name": "GRAV ES",
        "authorized_official_first_name": "DAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "425-235-9614",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "17917",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1620509",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sujatha Manthini, M.D
• Marisa Ann Manus, ATC
• Yu Mao, D.D.S.
• Ramla Maow
• Maranatha Medical Clinic Inc P S
• Nicole Anna Marchese
• Noelle Marchesini, RN
• Leah Marie Marcotte, M.D.
• Marcus R Kauffman, M.D., PLLC
• Eduardo Saul Margo, M.D.

• Internal Medicine Physician in Renton, WA
• Providers in Renton, WA by specialty
• Internal Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2017; 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.