Provider Demographics
NPI:1235171307
Name:CONSORTI, EILEEN T (MD)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:T
Last Name:CONSORTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:T
Other - Last Name:CONSORTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1035 116TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4604
Mailing Address - Country:US
Mailing Address - Phone:425-688-5000
Mailing Address - Fax:
Practice Address - Street 1:1135 116TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4695
Practice Address - Country:US
Practice Address - Phone:425-688-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61217792208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG86587OtherSTATE MEDICAL LICENSE
CABC6894035OtherFEDERAL DEA LICENSE
CA00G865871Medicare ID - Type Unspecified
CAH22815Medicare UPIN