Provider Demographics
NPI:1346258936
Name:AYOUBZADEH-BARTOS, NEGAR (PA-C)
Entity Type:Individual
Prefix:MS
First Name:NEGAR
Middle Name:
Last Name:AYOUBZADEH-BARTOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34876
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1876
Mailing Address - Country:US
Mailing Address - Phone:425-656-5412
Mailing Address - Fax:425-656-4096
Practice Address - Street 1:10555 SE CARR RD
Practice Address - Street 2:BLDG M
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5820
Practice Address - Country:US
Practice Address - Phone:425-656-4270
Practice Address - Fax:425-656-4271
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60563323363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2046961Medicaid
WI462364941Medicare PIN
WI019940720Medicare PIN