Provider Demographics
NPI:1740272673
Name:BAGATELL, CARRIE J (MD)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:J
Last Name:BAGATELL
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 1:16259 SYLVESTER RD SW
Mailing Address - Street 2:SUITE 504
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3049
Mailing Address - Country:US
Mailing Address - Phone:206-242-7900
Mailing Address - Fax:206-248-1551
Practice Address - Street 1:16259 SYLVESTER RD SW
Practice Address - Street 2:SUITE 504
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3049
Practice Address - Country:US
Practice Address - Phone:206-242-7900
Practice Address - Fax:206-248-1551
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024887207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1112044Medicaid
WA110214053OtherRR MEDICARE
WA1112044Medicaid
F82989Medicare UPIN