Provider Demographics
NPI:1831181700
Name:SHALIT, PETER (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:SHALIT
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 1:901 BOREN AVE STE 850
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3301
Mailing Address - Country:US
Mailing Address - Phone:206-624-0688
Mailing Address - Fax:206-624-2432
Practice Address - Street 1:901 BOREN AVE STE 850
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3301
Practice Address - Country:US
Practice Address - Phone:206-624-0688
Practice Address - Fax:206-624-2432
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA23946207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA110097492OtherRAILROAD MEDICARE
WA1301498Medicaid
WA4207422OtherAETNA PROVIDER NUMBER
WASH2229OtherREGENCE PROVIDER NUMBER
WA70246OtherL & I PROVIDER NUMBER
WA000109866Medicare ID - Type Unspecified
WASH2229OtherREGENCE PROVIDER NUMBER