Provider Demographics
NPI:1033226378
Name:DUESTERHOEFT, SARA MAE (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MAE
Last Name:DUESTERHOEFT
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 1:551 N 34TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8675
Mailing Address - Country:US
Mailing Address - Phone:206-374-9000
Mailing Address - Fax:206-774-3412
Practice Address - Street 1:551 N 34TH ST STE 100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8675
Practice Address - Country:US
Practice Address - Phone:206-374-9000
Practice Address - Fax:206-774-3412
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD28228207ZP0102X
WAMD00046699207ZP0102X, 207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8537813Medicaid
ORR141834Medicare PIN
WA8537813Medicaid