Provider Demographics
NPI:1891824116
Name:BITTNER, STEPHEN JON (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JON
Last Name:BITTNER
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 1:10200 NE 132ND ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2831
Mailing Address - Country:US
Mailing Address - Phone:425-821-2000
Mailing Address - Fax:425-820-3533
Practice Address - Street 1:10200 NE 132ND ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2831
Practice Address - Country:US
Practice Address - Phone:425-821-2000
Practice Address - Fax:425-820-3533
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2017-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT174372084P0800X
WA600010882084P0800X
OH35.0915182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
370000139Medicare PIN
B83151Medicare UPIN