Provider Demographics
NPI:1245394170
Name:POISSON, SUJATA C (MD)
Entity Type:Individual
Prefix:MRS
First Name:SUJATA
Middle Name:C
Last Name:POISSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SUJATA
Other - Middle Name:K
Other - Last Name:KATHANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3600 LIND AVE SW
Mailing Address - Street 2:SUITE 100 ATTN CREDENTIALING
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4970
Mailing Address - Country:US
Mailing Address - Phone:425-690-2715
Mailing Address - Fax:
Practice Address - Street 1:400 S 43RD ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055
Practice Address - Country:US
Practice Address - Phone:425-656-5566
Practice Address - Fax:425-656-5567
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031741207R00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine