Provider Demographics
NPI:1831291178
Name:LAW, THERESE (MD)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:LAW
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 1:320 NE 97TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2042
Mailing Address - Country:US
Mailing Address - Phone:206-323-8113
Mailing Address - Fax:306-323-1457
Practice Address - Street 1:320 NE 97TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2042
Practice Address - Country:US
Practice Address - Phone:206-323-8113
Practice Address - Fax:306-323-1457
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA18491207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1109198Medicaid
AB12464Medicare ID - Type Unspecified
WA1109198Medicaid