Provider Demographics
NPI:1720057235
Name:KITCHELL, CAROLYN CLAAR (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:CLAAR
Last Name:KITCHELL
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:PO BOX 3941
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3941
Mailing Address - Country:US
Mailing Address - Phone:206-386-2676
Mailing Address - Fax:206-386-2709
Practice Address - Street 1:747 BROADWAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4307
Practice Address - Country:US
Practice Address - Phone:206-386-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024169207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA203977OtherLABOR & INDUSTRIES
WAG8855812Medicare PIN
WA203977OtherLABOR & INDUSTRIES
WAG8861531Medicare PIN
WAP00265479Medicare PIN