Provider Demographics
NPI:1275507105
Name:ENGELBRECHT, DIANE E (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:E
Last Name:ENGELBRECHT
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 1:19020 33RD AVE W
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4746
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W
Practice Address - Street 2:SUITE 210
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4746
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031424174400000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1006476Medicaid
WA349480OtherL&I-EVERGREEN RADIA
WA8150294Medicaid
300064814OtherRAILROAD MEDICARE
WA109082OtherL&I
WAEN3948OtherREGENCE
WA349474OtherL&I-RADIA KING COUNTY
WA349476OtherL&I-SWEDISH RADIA
0870618OtherAETNA
WA349478OtherL&I-RADIA REST OF WA
WA8919495OtherCRIME VICTIMS
WAP01623671Medicare PIN
WAG8948928Medicare PIN
0870618OtherAETNA
WAG8949324Medicare PIN
WA109082OtherL&I
WAP01623655Medicare PIN
WAP01623665Medicare PIN
WA349478OtherL&I-RADIA REST OF WA
WAG8948918Medicare PIN