Provider Demographics
NPI:1447478938
Name:CHENOWETH, MARSHA ALEXIS (MD)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:ALEXIS
Last Name:CHENOWETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 114TH AVE SE STE 180
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6955
Mailing Address - Country:US
Mailing Address - Phone:425-451-1134
Mailing Address - Fax:425-451-8501
Practice Address - Street 1:1601 114TH AVE SE STE 180
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6955
Practice Address - Country:US
Practice Address - Phone:425-451-1134
Practice Address - Fax:425-451-8501
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 604763012084P0804X, 208000000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry