Provider Demographics
NPI:1942257951
Name:CONSTANTIN, FLAVIA TOMA (MD)
Entity Type:Individual
Prefix:DR
First Name:FLAVIA
Middle Name:TOMA
Last Name:CONSTANTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:FLAVIA
Other - Middle Name:
Other - Last Name:TOMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:425-391-5700
Mailing Address - Fax:425-391-5701
Practice Address - Street 1:911 N 10TH PL
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-0009
Practice Address - Country:US
Practice Address - Phone:425-391-5700
Practice Address - Fax:425-391-5701
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA178049719207Q00000X
WAMD00046155207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8456774Medicaid
WA8456774Medicaid
WAI55807Medicare UPIN