Provider Demographics
NPI:1295792109
Name:DY, GRACE T (MD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:T
Last Name:DY
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:PO BOX 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:425-899-3292
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:17000 140TH AVE NE
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-6942
Practice Address - Country:US
Practice Address - Phone:425-488-2273
Practice Address - Fax:425-488-4971
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037246207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8241432Medicaid
WA228589OtherLABOR & INDUSTRIES
WA228589OtherLABOR & INDUSTRIES
WA8241432Medicaid
WAAB13570Medicare ID - Type Unspecified
WAG8870472Medicare PIN
WAG8896425Medicare PIN
WAG8870474Medicare PIN