Provider Demographics
NPI:1750379004
Name:HARTWELL, PETER S (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:S
Last Name:HARTWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16233 SYLVESTER RD SW
Mailing Address - Street 2:G-20
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3045
Mailing Address - Country:US
Mailing Address - Phone:206-431-9771
Mailing Address - Fax:206-431-5484
Practice Address - Street 1:16233 SYLVESTER RD SW
Practice Address - Street 2:G-20
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3045
Practice Address - Country:US
Practice Address - Phone:206-431-9771
Practice Address - Fax:206-431-5484
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019997207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1083583Medicaid
WA2216827OtherAETNA
WA100016506OtherRR MEDICARE
WA43442OtherL&I
WAHA6009OtherREGENCE PROV #
WA1083583Medicaid
WAG000120477Medicare ID - Type Unspecified
WAG000120477Medicare PIN