Provider Demographics
NPI:1558476960
Name:ROMANICK, SUE (MD)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:ROMANICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:ROMANICK SCHMIEDL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11522 NE 20TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3005
Mailing Address - Country:US
Mailing Address - Phone:425-462-2531
Mailing Address - Fax:425-454-6176
Practice Address - Street 1:11522 NE 20TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3005
Practice Address - Country:US
Practice Address - Phone:425-462-2531
Practice Address - Fax:425-454-6176
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028590207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91-2051818OtherCOMMERCIAL
WA1113166Medicaid
WA151480OtherLABOR & INDUSTRY
WARO3836OtherBLUE SHIELD REGENCE
WARO3836OtherBLUE SHIELD REGENCE
WA1113166Medicaid