Provider Demographics
NPI:1992832588
Name:HENNINGER, TONYA (MD)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:HENNINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 9TH AVE. MAILSTOP H8-25
Mailing Address - Street 2:VIRGINIA MASON MEDICAL CENTER
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-341-0860
Mailing Address - Fax:206-583-2307
Practice Address - Street 1:1100 9TH AVE. MAILSTOP H8-25
Practice Address - Street 2:VIRGINIA MASON MEDICAL CENTER
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-341-0860
Practice Address - Fax:206-583-2307
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047358207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8478653Medicaid
WAG8874362Medicare PIN