Provider Demographics
NPI:1467688069
Name:WINTERROTH, LISA CHRISTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:CHRISTINE
Last Name:WINTERROTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9725 3RD AVE NE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2060
Mailing Address - Country:US
Mailing Address - Phone:206-527-2577
Mailing Address - Fax:206-527-2514
Practice Address - Street 1:9725 3RD AVE NE
Practice Address - Street 2:SUITE 500
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2060
Practice Address - Country:US
Practice Address - Phone:206-527-2577
Practice Address - Fax:206-527-2514
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60360628208000000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2028941Medicaid
WA2028941Medicaid
WAG8941644Medicare UPIN
WAG8941646Medicare UPIN
WAG8941643Medicare UPIN