Provider Demographics
NPI:1831364470
Name:FALLAH, MAHEEN (MD)
Entity type:Individual
Prefix:
First Name:MAHEEN
Middle Name:
Last Name:FALLAH
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 1:12333 NE 130TH LANE SUITE 110
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034
Mailing Address - Country:US
Mailing Address - Phone:425-285-0060
Mailing Address - Fax:425-285-0070
Practice Address - Street 1:12333 NE 130TH LANE SUITE 110
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-285-0060
Practice Address - Fax:425-285-0070
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60085796207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
81778OtherTRAINING PERMIT