Provider Demographics
NPI:1508043571
Name:PETER SHALIT, M.D.
Entity Type:Organization
Organization Name:PETER SHALIT, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCLARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-624-1441
Mailing Address - Street 1:901 BOREN AVE STE 850
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3301
Mailing Address - Country:US
Mailing Address - Phone:206-624-0688
Mailing Address - Fax:
Practice Address - Street 1:901 BOREN AVE STE 850
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3301
Practice Address - Country:US
Practice Address - Phone:206-624-0688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023946207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4207422OtherAETNA
WA70246OtherL&I
WA1301498Medicaid
WASH2229OtherREGENCE BLUE SHIELD
WA4207422OtherAETNA
WA000109866Medicare PIN