MEDICARE: M. GRETCHEN TODD PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA10003883	WA

General Provider Information

NPI Number	:	1760471965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	M. GRETCHEN TODD PA-C

Provider Business Mailing Address
First Line	:	PO BOX 3489
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98114-3489
Country	:	US
Telephone Number	:	206-386-9500
Fax Number	:	206-576-3802

Provider Business Practice Location Address
First Line	:	1229 MADISON ST
Second Line	:	SUITE 1500
City	:	SEATTLE
State	:	WA
Zip	:	98104-3586
Country	:	US
Telephone Number	:	206-386-9500
Fax Number	:	206-292-7967

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	07/08/2007

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