Provider Demographics
NPI:1477642411
Name:STRICK, LARA B (MD)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:B
Last Name:STRICK
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 1:3667 33RD AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-2369
Mailing Address - Country:US
Mailing Address - Phone:206-715-1186
Mailing Address - Fax:
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2499
Practice Address - Country:US
Practice Address - Phone:206-744-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040129207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3719STOtherBLUE SHIELD #
WA0039574OtherLABOR AND INDUSTRIES #
WA8401580Medicaid
WAUS7915721OtherAETNA SPECIALIST PIN
WA3719STOtherBLUE SHIELD #
I34957Medicare UPIN
WA8401580Medicaid
WA8862816Medicare PIN
P00255723Medicare ID - Type UnspecifiedRAILROAD MC#