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Maralyssa Angelique Bann

Hospitalist

Allopathic & Osteopathic Physicians

PECOS Enrollment

This provider is enrolled in PECOS as MARALYSSA BANN.

Based on the most recent information from CMS, provider Maralyssa Angelique Bann is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 9:59 AM.

Profile Details

Provider ID
1922337021
Provider Type
Individual
Full Name
Bann, Maralyssa Angelique
Credential
M.D.

Gender
Female
Sole Proprietor
No
Enumeration Date
12/18/2009
Last Updated
11/2/2017

Contact Information

Practice Location

325 9th Ave, Seattle, WA 98104-2420

(206) 744-3000

Unlisted Fax

Mailing Location

PO Box 50095, Seattle, WA 98145-5095

(206) 543-6420

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 208M00000X Primary	Description Hospitalist Allopathic & Osteopathic Physicians	License MD60400820 Washington
Code 207R00000X	Description Internal Medicine Allopathic & Osteopathic Physicians	License MD60400820 Washington

Provider Identifiers

ID	Description	Issuer
ID 8928081	Description Other	Issuer MEDICARE PIN Washington
ID 1922337021	Description Medicaid	Issuer Unlisted Washington

Maralyssa Angelique Bann

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

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License

Provider Identifiers

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Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

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