Provider Demographics
NPI:1487757332
Name:COLTRERA, MARC DANTE (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:DANTE
Last Name:COLTRERA
Suffix:
Gender:M
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: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:206-520-5307
Mailing Address - Fax:
Practice Address - Street 1:DEPT. OTO-HNS, UNIVERSITY OF WASHINGTON
Practice Address - Street 2:1959 NE PACIFIC
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195
Practice Address - Country:US
Practice Address - Phone:206-543-5230
Practice Address - Fax:206-543-5152
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023846207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8105272Medicaid
WAA55585Medicare UPIN