Provider Demographics
NPI:1932299823
Name:LOREN, DAVIA L (MD)
Entity Type:Individual
Prefix:
First Name:DAVIA
Middle Name:L
Last Name:LOREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:J
Other - Last Name:LOREN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4800 SAND POINT WAY NE # 100
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3901
Mailing Address - Country:US
Mailing Address - Phone:206-987-2000
Mailing Address - Fax:
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000435462080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
323120OtherINTERNAL ID-MOTOR VEHICLE ID
WA8396624Medicaid
I14049Medicare UPIN
8806251Medicare ID - Type Unspecified