Provider Demographics
NPI:1447207659
Name:AUERBACH, PATRICIA CHRISTINA (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:CHRISTINA
Last Name:AUERBACH
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 1:3600 LIND AVE SW
Mailing Address - Street 2:SUITE 100 ATTN CREDENTIALING
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4970
Mailing Address - Country:US
Mailing Address - Phone:425-690-2715
Mailing Address - Fax:
Practice Address - Street 1:10555 SE CARR RD BLDG M
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055
Practice Address - Country:US
Practice Address - Phone:425-690-3470
Practice Address - Fax:425-690-9470
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039457207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4554AUOtherBLUE SHIELD #
WA0039581OtherLABOR AND INDUSTRIES #
WA1056504Medicaid
WA8500597Medicaid
G8873600OtherMEDICARE NUMBER FOR WINSLOW LOCATION
WAG8979445OtherMEDICARE
WAG8979445OtherMEDICARE W VALLEY MEDICAL GROUP - RENTON