Provider Demographics
NPI:1669596615
Name:TAYLOR, SUSANNAH I (MD)
Entity type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:I
Last Name:TAYLOR
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 1:325 9TH AVE
Mailing Address - Street 2:BOX 359755
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2420
Mailing Address - Country:US
Mailing Address - Phone:206-744-9102
Mailing Address - Fax:206-744-9976
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:BOX 359755
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2420
Practice Address - Country:US
Practice Address - Phone:206-744-9102
Practice Address - Fax:206-744-9976
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027533207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8222523Medicaid
WA8222523Medicaid
WAG8804687Medicare PIN