Provider Demographics
NPI:1346273158
Name:PATHY, SUMATHY T (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMATHY
Middle Name:T
Last Name:PATHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUMATHY
Other - Middle Name:
Other - Last Name:THIYAGARAJAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11420 NE20TH STREET
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1501
Mailing Address - Country:US
Mailing Address - Phone:425-688-5470
Mailing Address - Fax:425-688-5605
Practice Address - Street 1:11420 NE 20TH ST STE A
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3007
Practice Address - Country:US
Practice Address - Phone:452-688-5777
Practice Address - Fax:425-369-1435
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1117753Medicaid
WAMD00042001OtherMD LICENSE
WAMD00042001OtherMD LICENSE
WAH76244Medicare UPIN
WABP7985952OtherDEA