Provider Demographics
NPI:1275589871
Name:DOO, ELLA C (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLA
Middle Name:C
Last Name:DOO
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 1:19020 33RD AVE W
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4746
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W
Practice Address - Street 2:SUITE 210
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4746
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1374
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000185722085R0202X
WA00018572174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA241015OtherLNI PROVIDER ID
WA1042258Medicaid
WA2079DOOtherREGENCE BLUE SHIELD
WA8851106Medicare PIN
WA1042258Medicaid
WAG8877372Medicare PIN
WAG8876285Medicare PIN
WAG8892144Medicare PIN
WAP01247753Medicare PIN
WA8876286Medicare PIN
WA241015OtherLNI PROVIDER ID