Provider Demographics
NPI:1649466020
Name:FORD, JANET MARTHA (MD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:MARTHA
Last Name:FORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:MARTHA
Other - Last Name:GANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
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:# 101
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-6928
Practice Address - Country:US
Practice Address - Phone:425-488-2273
Practice Address - Fax:425-488-4971
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035547207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8505885Medicaid
WATAX IDENTIFICATIONOther91-2002750
WATAX IDENTIFICATIONOther91-2002750
WAG8873888Medicare PIN
WAG8876313Medicare PIN
WA8505885Medicaid
WAG8893828Medicare PIN
WAG8873887Medicare PIN