Provider Demographics
NPI:1225190978
Name:FADER, SETH P (DO)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:P
Last Name:FADER
Suffix:
Gender:M
Credentials:DO
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 1281
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98009-1281
Mailing Address - Country:US
Mailing Address - Phone:425-301-8190
Mailing Address - Fax:425-300-1081
Practice Address - Street 1:2513 152ND AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5574
Practice Address - Country:US
Practice Address - Phone:425-301-8190
Practice Address - Fax:425-300-1081
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00002004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0198791OtherLABOR AND INDUSTRIES
WA8430019Medicaid
WA8430019Medicaid
WA8854454Medicare ID - Type Unspecified