| Doctor Name: | DR. MARC D PELLICCIARO |
| NPI Number: | 1962575951 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | MD 00036813 |
| Business Practice Address: | 10322 Ne 132nd St Kirkland, WA - 980342829 |
| Business Phone Number: | 4258233116 |
| Business Fax Number: | 4258233132 |
| Mailing Address: | 103222 Ne 132nd Street, KIRKLAND |
| State: | WA |
| Postal Code: | 98034 |
| Phone Number: | 4258233116 |
| Fax Number: | 4258233132 |
| NPI Enumeration Date: | 11/16/2006 |
| NPI Last Update Date: | 04/05/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2084A0401X |
| License Number: | MD 00036813 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Psychiatry & Neurology |
| Taxonomy Specialization: | Addiction Medicine |
| Taxonomy Definition: | A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |