Provider Demographics
NPI:1235167180
Name:PEZZOLESI, INGELA (MD)
Entity Type:Individual
Prefix:
First Name:INGELA
Middle Name:
Last Name:PEZZOLESI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:INGELA
Other - Middle Name:
Other - Last Name:THOMSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9621 RIDGETOP BLVD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383
Mailing Address - Country:US
Mailing Address - Phone:360-782-3200
Mailing Address - Fax:
Practice Address - Street 1:9398 RIDGETOP BLVD NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8505
Practice Address - Country:US
Practice Address - Phone:360-782-3200
Practice Address - Fax:360-782-3242
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035255207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5035653OtherAETNA
TH4159OtherREGENCE BLUE SHIELD
WA121701OtherLABOR & INDUSTRIES
WA8224776Medicaid
WA8928302OtherCRIME VICTIMS COMP
080121832OtherRAILROAD MEDICARE
080121832OtherRAILROAD MEDICARE
BT5884146OtherDEA
WAGAB04822Medicare PIN
WA121701OtherLABOR & INDUSTRIES
G65310Medicare UPIN
WA8224776Medicaid
WAGAB03973Medicare PIN
TH4159OtherREGENCE BLUE SHIELD
5035653OtherAETNA
WAGAB04816Medicare PIN