Provider Demographics
NPI:1225209471
Name:CARPENTER, JOHN BISCHOFF (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BISCHOFF
Last Name:CARPENTER
Suffix:
Gender:M
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 34888
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1888
Mailing Address - Country:US
Mailing Address - Phone:425-977-4620
Mailing Address - Fax:425-745-9836
Practice Address - Street 1:19000 33RD AVE W
Practice Address - Street 2:STE 230
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4752
Practice Address - Country:US
Practice Address - Phone:425-686-7138
Practice Address - Fax:425-745-4104
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ80848207ZP0101X
WAMD 60139285207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2008051Medicaid
WA0317315OtherLABOR AND INDUSTRIES
WAG8924674Medicare PIN
WA0317315OtherLABOR AND INDUSTRIES
WAG8924672Medicare PIN