Provider Demographics
NPI:1134296452
Name:TAYADE, ARTI S (MD)
Entity Type:Individual
Prefix:
First Name:ARTI
Middle Name:S
Last Name:TAYADE
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:PO BOX 1968
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-1968
Mailing Address - Country:US
Mailing Address - Phone:253-922-5623
Mailing Address - Fax:253-922-5009
Practice Address - Street 1:21845 NE 104TH PL
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-7680
Practice Address - Country:US
Practice Address - Phone:425-868-2923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039289207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8266017Medicaid
AB28556OtherMEDICARE ID TYPE
WAG8917717Medicare PIN
AB28556OtherMEDICARE ID TYPE