Provider Demographics
NPI:1265404255
Name:HARVEY, SUSAN M (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:HARVEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:GAIL
Other - Last Name:MEINHOLTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1101 MADISON ST
Mailing Address - Street 2:STE 950
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3592
Mailing Address - Country:US
Mailing Address - Phone:206-682-5800
Mailing Address - Fax:206-233-9657
Practice Address - Street 1:1101 MADISON ST
Practice Address - Street 2:STE 950
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3592
Practice Address - Country:US
Practice Address - Phone:206-682-5800
Practice Address - Fax:206-233-9657
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026860207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7086887Medicaid
WA7086887Medicaid