Provider Demographics
NPI:1710948740
Name:CLABOTS, M. TERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:M.
Middle Name:TERESA
Last Name:CLABOTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7424 BRIDGEPORT WAY W
Mailing Address - Street 2:SUITE 307
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8120
Mailing Address - Country:US
Mailing Address - Phone:253-588-6574
Mailing Address - Fax:253-588-2688
Practice Address - Street 1:7424 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE 307
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8120
Practice Address - Country:US
Practice Address - Phone:253-588-6574
Practice Address - Fax:253-588-2688
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD000235272080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1017854Medicaid
WAE79280Medicare UPIN