Provider Demographics
NPI:1932284734
Name:ERLANGER, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ERLANGER
Suffix:
Gender:F
Credentials:
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 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-543-6420
Mailing Address - Fax:
Practice Address - Street 1:UW CAMPUS
Practice Address - Street 2:EAST STEVENS CIRCLE
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-4410
Practice Address - Country:US
Practice Address - Phone:206-616-2495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0201336OtherL&I
WA1932284734Medicaid
2002630OtherINTERNAL ID-MOTOR VEHICLE ID
G70090Medicare UPIN
WA1932284734Medicaid