Provider Demographics
NPI:1710991237
Name:SUSSMAN, ALLEN M (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:M
Last Name:SUSSMAN
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:PO BOX 59028
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-2028
Mailing Address - Country:US
Mailing Address - Phone:425-251-5110
Mailing Address - Fax:425-793-4707
Practice Address - Street 1:723 SW 10TH ST
Practice Address - Street 2:STE 250
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055
Practice Address - Country:US
Practice Address - Phone:425-656-4040
Practice Address - Fax:425-656-4046
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015978207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0016607OtherL&I
WA110202799OtherRR MEDICARE
WA1487800Medicaid
WA217139102Medicare PIN
WA110202799OtherRR MEDICARE