Provider Demographics
NPI:1225259187
Name:LOISELLE, CHRISTOPHER R (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:R
Last Name:LOISELLE
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 749730
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-9730
Mailing Address - Country:US
Mailing Address - Phone:855-743-5921
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:1221 MADISON ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3589
Practice Address - Country:US
Practice Address - Phone:206-386-2323
Practice Address - Fax:206-386-2393
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD601017942085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8448193Medicaid
WAG8902812Medicare PIN