Provider Demographics
NPI:1083765515
Name:PESENSON, ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:
Last Name:PESENSON
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 1:904 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1132
Mailing Address - Country:US
Mailing Address - Phone:206-860-4478
Mailing Address - Fax:206-325-5150
Practice Address - Street 1:904 7TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1132
Practice Address - Country:US
Practice Address - Phone:206-860-4478
Practice Address - Fax:206-325-5150
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 00046540207RN0300X
NJ25MA08298200207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00847698OtherRAILROAD
WA0255550OtherSTATE L&I
WA0273315OtherSTATE L&I
WAP00847698OtherRAILROAD
WA353160Medicare UPIN
WAG8886638Medicare PIN