Provider Demographics
NPI:1598791576
Name:FALKENBERG, GISELLE (MD)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:FALKENBERG
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 1:357 NW RICHMOND BEACH RD
Mailing Address - Street 2:RICHMOND PEDIATRICS
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177
Mailing Address - Country:US
Mailing Address - Phone:206-546-2421
Mailing Address - Fax:206-546-8436
Practice Address - Street 1:357 NW RICHMOND BEACH RD
Practice Address - Street 2:RICHMOND PEDIATRICS
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177
Practice Address - Country:US
Practice Address - Phone:206-546-2421
Practice Address - Fax:206-546-8436
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA27797208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8138869Medicaid
WA8138869Medicaid
WA21510701Medicare ID - Type Unspecified