Provider Demographics
NPI:1720051618
Name:HOLT, SUSAN E (PAC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:HOLT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 OLIVE WAY
Mailing Address - Street 2:MS: M4-PA
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1873
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:206-515-5886
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:2006-02-10
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10001006207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAUS0862204OtherAETNA SPECIALIST PIN
WA069741009OtherINDIVIDAUL GROUP HEALTH
WA8368136Medicaid
WA0039583OtherL & I
WA3331HOOtherINDIVIDUAL BLUE SHIELD
WA970015908OtherRAILROAD MEDICARE
WA8368136Medicaid
WA069741009OtherINDIVIDAUL GROUP HEALTH