Provider Demographics
NPI:1851424931
Name:BAINBRIDGE PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:BAINBRIDGE PEDIATRICS, PLLC
Other - Org Name:CWW PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:OTTMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-780-5437
Mailing Address - Street 1:1298 GROW AVE NW
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110
Mailing Address - Country:US
Mailing Address - Phone:206-780-5437
Mailing Address - Fax:206-780-5438
Practice Address - Street 1:1298 GROW AVE NW
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110
Practice Address - Country:US
Practice Address - Phone:206-780-5437
Practice Address - Fax:206-780-5438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6026367422080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty