Provider Demographics
NPI:1679598510
Name:ROBERT, GHISLAINE (MD)
Entity Type:Individual
Prefix:
First Name:GHISLAINE
Middle Name:
Last Name:ROBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GHISLAINE
Other - Middle Name:
Other - Last Name:ROBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8630 164TH AVE NE
Mailing Address - Street 2:205
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3606
Mailing Address - Country:US
Mailing Address - Phone:425-836-1800
Mailing Address - Fax:425-836-1877
Practice Address - Street 1:8630 164TH AVE NE
Practice Address - Street 2:205
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3606
Practice Address - Country:US
Practice Address - Phone:425-836-1800
Practice Address - Fax:425-836-1877
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000424872081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5576ROOtherBLUE SHIELD
WA0039594OtherLABOR & INDUSTRY
WA8390775Medicaid
WAUS7933591OtherAETNA/USHC SPECIALIST
WA8390775Medicaid
WA0039594OtherLABOR & INDUSTRY