Provider Demographics
NPI:1629002597
Name:SEAHURST PEDIATRICS PLLC
Entity Type:Organization
Organization Name:SEAHURST PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DESMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:RABINOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-242-7822
Mailing Address - Street 1:PO BOX 34935
Mailing Address - Street 2:DEPT # 61
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1935
Mailing Address - Country:US
Mailing Address - Phone:206-439-4888
Mailing Address - Fax:
Practice Address - Street 1:16233 SYLVESTER RD SW
Practice Address - Street 2:SUITE 230
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3045
Practice Address - Country:US
Practice Address - Phone:206-242-7822
Practice Address - Fax:206-244-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019385208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA06231Medicare UPIN