Provider Demographics
NPI:1154447217
Name:GERARD ZANOLLI MD PLLC
Entity Type:Organization
Organization Name:GERARD ZANOLLI MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZANOLLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-938-4200
Mailing Address - Street 1:5236 CALIFORNIA AVE SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1244
Mailing Address - Country:US
Mailing Address - Phone:206-938-4200
Mailing Address - Fax:
Practice Address - Street 1:5236 CALIFORNIA AVE SW
Practice Address - Street 2:SUITE B
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1244
Practice Address - Country:US
Practice Address - Phone:206-938-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000348122084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1101450Medicaid
WA1101450Medicaid