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Contact Information

MARISSA BLACK, MD
11521 NE 128TH ST STE 100
KIRKLAND, WA98034
 Phone: 425-899-6800
 Fax: 425-899-6818
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Geriatric Medicine

207RG0300X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for MARISSA BLACK · (Female)

NPI Number 1114269735
Status Active
Credentials MD
Entity Individual
Enumeration date 03/21/2013
Last updated 07/17/2019 - About 7 years ago
Sole proprietor 1 No
Identifiers
  • WA License # MD60371542
  • WA License # MD60571983
Hospital affiliation(s)
  • EVERGREEN HOSPITAL MEDICAL CENTER - (Acute Care)
    12040 NE 128TH STREET
    KIRKLAND, WA 98034
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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