Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Praveen Kumar Mambalam, MD

Individual provider Pain Medicine (Anesthesiology) Physician · NPI 1790942886

Praveen Kumar Mambalam, MD is an Anesthesiology in Edmonds, Washington. Qualified in 2004, 22 years ago. Practices with Pain and Spine Specialists of Maryland LLC, a 31-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Washington.

Years since qualifying
22
Licensed in
WA
In the registry since
2008
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

21616 76th Ave W Ste 102
Edmonds, WA 98026-7512
Phone: (425) 774-1538
Fax: (425) 744-1527
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 155 Lilly Rd Ne Ste B, Olympia, WA 98506-5028 — (206) 538-6300

Specialties & licences

Pain Medicine (Anesthesiology) Physician (primary) Taxonomy 207LP2900X · Licence MD 00049423 (WA)

Record details

NPI number1790942886
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMay 17, 2008
Last updated in NPPESMay 23, 2023
Certification dateMay 23, 2023

Medicare enrollment

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

Medicare specialtyANESTHESIOLOGY
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Pain And Spine Specialists Of Maryland Llc — 31 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

Other providers in Edmonds