Provider Demographics
NPI:1760690374
Name:DICKINSON, CORDELIA (MD)
Entity Type:Individual
Prefix:
First Name:CORDELIA
Middle Name:
Last Name:DICKINSON
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 1:500 19TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4072
Mailing Address - Country:US
Mailing Address - Phone:206-709-7112
Mailing Address - Fax:206-299-1633
Practice Address - Street 1:2101 E YESLER WAY STE 150
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122
Practice Address - Country:US
Practice Address - Phone:206-299-1900
Practice Address - Fax:206-299-1906
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine