Provider Demographics
NPI:1437315298
Name:LORENZ, EILEEN JOSEPHINE (MD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:JOSEPHINE
Last Name:LORENZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EILEEN
Other - Middle Name:JOSEPHINE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W STE 210
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4748
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD609398992085R0202X, 2085R0202X
TN516552085R0202X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0407739OtherL&I-SOUTH SOUND RADIOLOGY
WA2129571Medicaid
WA0407736OtherL&I-RADIA REST OF WA
WA0407738OtherL&I-SWEDISH RADIA EDMONDS
WA0407739OtherL&I-EVERGREEN RADIA
WA0407742OtherL&I-SEATTLE RADIOLOGY
WA0407737OtherL&I-RADIA KING COUNTY
TNQ006905Medicaid