Provider Demographics
NPI:1396772760
Name:SULTANA, GEOFFREY E (MD)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:E
Last Name:SULTANA
Suffix:
Gender:M
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 2078
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98071-2078
Mailing Address - Country:US
Mailing Address - Phone:253-293-5453
Mailing Address - Fax:866-581-5147
Practice Address - Street 1:202 N DIVISION ST
Practice Address - Street 2:400
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-4939
Practice Address - Country:US
Practice Address - Phone:253-293-5453
Practice Address - Fax:866-581-5147
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080108208100000X
WAMD60011758208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0238519OtherLABOR AND INDUSTTRY
OH2696239Medicaid
WA8525024Medicaid
WA3114SUOtherREGENCE
I59723Medicare UPIN
OH2696239Medicaid
OHSU4191132Medicare ID - Type Unspecified