Provider Demographics
NPI:1669414405
Name:HORAN, KATHLEEN LESLEY (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:LESLEY
Last Name:HORAN
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 1:1100 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042414207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAUS7694846OtherAETNA SPECIALIST PIN
WA5866HOOtherBLUE SHIELD #
WA8458655Medicaid
WAP00348774OtherRAILROAD MC #
WA8886233OtherMEDICARE PTAN
WAUS7694846OtherAETNA SPECIALIST PIN
WA8861842Medicare PIN
WA8458655Medicaid
WA8868539Medicare PIN
WA8895309Medicare PIN
WAP00348774OtherRAILROAD MC #