Provider Demographics
NPI:1245573385
Name:ADDISON, ERIN JEAN (MD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:JEAN
Last Name:ADDISON
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 1:12040 NE 128TH ST
Mailing Address - Street 2:MS 105
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3013
Mailing Address - Country:US
Mailing Address - Phone:425-899-2560
Mailing Address - Fax:425-899-2079
Practice Address - Street 1:12040 NE 128TH ST
Practice Address - Street 2:MS 105
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3013
Practice Address - Country:US
Practice Address - Phone:425-899-2560
Practice Address - Fax:425-899-2079
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60580679207R00000X
WAML60361760207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine