Provider Demographics
NPI:1568673887
Name:TELLINGHUISEN, AMY FOWLER (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:FOWLER
Last Name:TELLINGHUISEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5371
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5005
Mailing Address - Country:US
Mailing Address - Phone:206-987-2106
Mailing Address - Fax:206-987-3946
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-2106
Practice Address - Fax:206-987-3946
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA609753762080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187986803Medicaid
TXTXB141946Medicare PIN