Provider Demographics
NPI:1346339751
Name:GAWTHROP, LAINE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAINE
Middle Name:MARIE
Last Name:GAWTHROP
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 1:12910 TOTEM LAKE BLVD NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2954
Mailing Address - Country:US
Mailing Address - Phone:425-814-5000
Mailing Address - Fax:
Practice Address - Street 1:12910 TOTEM LAKE BLVD NE
Practice Address - Street 2:SUITE 101
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2954
Practice Address - Country:US
Practice Address - Phone:425-814-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL27160207R00000X
WAMD60074830207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8554024Medicaid
WA8899593Medicare PIN
WAG8884362Medicare PIN