Provider Demographics
NPI:1760593362
Name:FLEMING, JUDITH ARIELA (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ARIELA
Last Name:FLEMING
Suffix:
Gender:F
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 1:660 SW 39TH ST
Practice Address - Street 2:STE 150
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4912
Practice Address - Country:US
Practice Address - Phone:425-793-4700
Practice Address - Fax:425-656-4046
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046889207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00046889OtherSTATE MEDICAL LICENSE
WA0239323OtherL&I
WA6478FLOtherREGENCE
WA8467714Medicaid
WAP00662028OtherMEDICARE RAILROAD
WAP00662028OtherMEDICARE RAILROAD