Provider Demographics
NPI:1639107634
Name:GHODS, MASSIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MASSIE
Middle Name:
Last Name:GHODS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 1ST AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1123
Mailing Address - Country:US
Mailing Address - Phone:206-448-2516
Mailing Address - Fax:206-448-6473
Practice Address - Street 1:1414 116TH AVE NE
Practice Address - Street 2:SUITE E
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3801
Practice Address - Country:US
Practice Address - Phone:206-215-4545
Practice Address - Fax:206-215-4550
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027593207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0194901OtherL & I
WA8283780Medicaid
WA0194901OtherL & I
WAG8801204Medicare PIN