Provider Demographics
NPI:1942525498
Name:GERIATRIC MEDICINE ,LLC
Entity Type:Organization
Organization Name:GERIATRIC MEDICINE ,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:PINTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-601-6149
Mailing Address - Street 1:12819 SE 38TH ST
Mailing Address - Street 2:PMB243
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1326
Mailing Address - Country:US
Mailing Address - Phone:206-601-6149
Mailing Address - Fax:
Practice Address - Street 1:3980 129TH PL SE APT B201
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-5293
Practice Address - Country:US
Practice Address - Phone:206-601-6149
Practice Address - Fax:206-219-5598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028124207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0241685OtherL & I
WA8527749Medicaid
WAC811762Medicare PIN
E47876Medicare UPIN