Marc D Pellicciaro, M.D.

Primary specialty

Addiction Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084A0401X

License

MD 00036813 Issued in WA

Practice address

12729 Northup Way Ste 6
Bellevue, WA 98005-1935

Phone

(425) 467-1000

Fax

(425) 467-0100

NPI assigned

Nov 16, 2006

Reactivated

May 16, 2018

Last updated

Apr 17, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Magnolia Psychiatry, LLC

  • Addiction Psychiatry Physician
  • Bellevue, WA
  • NPI 1003346594
  NPD (past) Authorized official
• Phillip W Neuberger MD LLC

  dba Behavioral Medicine of Alaska

  • Child & Adolescent Psychiatry Physician
  • Anchorage, AK
  • NPI 1114117272
  NPD (past)

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555459200000",
    "number": "1962575951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": {
        "last_name": "PELLICCIARO",
        "first_name": "MARC",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-16",
        "last_updated": "2019-04-17",
        "deactivation_date": "2018-05-09",
        "reactivation_date": "2018-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "WA",
            "license": "MD 00036813",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valeria R Pedraza Valdovinos
• Molly Peebles, LMT
• Bryon Peeples
• Elizabeth Alice Gates Peijnenburg, MD
• Dana Pellegrini, LMP
• Elena Luisa Pellicer, MD
• Richard Stuart Pelman, MD
• Sophia Pelzer
• Marisol Pena, LMT
• Mariela Penalverty Morales, RD

• Addiction Medicine (Psychiatry & Neurology) Physician in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Addiction Medicine (Psychiatry & Neurology) 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.