Provider Demographics
NPI:1912067331
Name:PASCUALY, RALPH A (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:A
Last Name:PASCUALY
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:PO BOX 84026
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-8426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 17TH AVE
Practice Address - Street 2:STE A20
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5788
Practice Address - Country:US
Practice Address - Phone:206-386-4744
Practice Address - Fax:206-215-1135
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000175262084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0153376OtherLABOR AND INDUSTRIES
WA8250411Medicaid
WA0153376OtherLABOR AND INDUSTRIES
WA8250411Medicaid