Provider Demographics
NPI:1225377369
Name:MASTEN, SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:
Last Name:MASTEN
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 1:10453 MAPLEWOOD PL SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-1076
Mailing Address - Country:US
Mailing Address - Phone:206-696-4680
Mailing Address - Fax:206-937-2629
Practice Address - Street 1:3101 WESTERN AVE STE 600
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-3047
Practice Address - Country:US
Practice Address - Phone:206-696-4680
Practice Address - Fax:206-937-2629
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-09
Last Update Date:2013-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027009207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine