Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mark D Coram, PA-C

Individual provider Physician Assistant · NPI 1407184021

Mark D Coram, PA-C is a Physician Assistant in Walla Walla, Washington. Qualified in 2009, 17 years ago. Practices with Providence Health and Services - Washington, a 264-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Washington.

Years since qualifying
17
Licensed in
WA
In the registry since
2009
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

401 W Poplar St Psmpg Sleep Medicine
Walla Walla, WA 99362-2846
Phone: (509) 522-5845
Fax: (509) 522-5527
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA60118218 (WA)

Record details

NPI number1407184021
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedNovember 19, 2009
Last updated in NPPESMay 10, 2021
Certification dateMay 10, 2021
Mailing addressPo Box 34439, Seattle, WA 98124-1439

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2009 (17 years in practice)
Group practice Providence Health And Services - Washington — 264 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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