Provider Demographics
NPI:1053775742
Name:MAHRER OWEN, CASSEDY MCCRIGHT (DO)
Entity type:Individual
Prefix:
First Name:CASSEDY
Middle Name:MCCRIGHT
Last Name:MAHRER OWEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CASSEDY
Other - Middle Name:MCCRIGHT
Other - Last Name:MAHRER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-520-5700
Mailing Address - Fax:
Practice Address - Street 1:10452 SILVERDALE WAY NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9411
Practice Address - Country:US
Practice Address - Phone:360-307-7300
Practice Address - Fax:877-777-9902
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61046548208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1053775742Medicaid