Provider Demographics
NPI:1437476637
Name:GRAVELIN, SARA MONIQUE (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MONIQUE
Last Name:GRAVELIN
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 1:5523 29TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5519
Mailing Address - Country:US
Mailing Address - Phone:303-809-1979
Mailing Address - Fax:
Practice Address - Street 1:11808 NORTHUP WAY
Practice Address - Street 2:SUITE W-120
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1936
Practice Address - Country:US
Practice Address - Phone:425-284-1548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60452294207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology