Provider Demographics
NPI:1033288188
Name:PASSLOFF, ELLEN SIMONE (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:SIMONE
Last Name:PASSLOFF
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 1:11545 15TH AVE NE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6358
Mailing Address - Country:US
Mailing Address - Phone:206-364-2010
Mailing Address - Fax:206-364-2432
Practice Address - Street 1:1201 N 175TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-5064
Practice Address - Country:US
Practice Address - Phone:206-401-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030068208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8154049Medicaid
WAAB24848Medicare ID - Type Unspecified
WA8154049Medicaid