Provider Demographics
NPI:1376628610
Name:SCHOLTEN, ROGER C (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:C
Last Name:SCHOLTEN
Suffix:
Gender:M
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:PO BOX 84026
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-8426
Mailing Address - Country:US
Mailing Address - Phone:206-320-5780
Mailing Address - Fax:
Practice Address - Street 1:3400 CALIFORNIA AVE SW, STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116
Practice Address - Country:US
Practice Address - Phone:206-320-5780
Practice Address - Fax:206-320-5794
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032193208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8160913Medicaid
F 51085Medicare UPIN
WA8160913Medicaid