Healthcare Provider Details

I. General information

NPI: 1538274949
Provider Name (Legal Business Name): SUE ROMANICK MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11522 NE 20TH ST
BELLEVUE WA
98004-3005
US

IV. Provider business mailing address

11522 NE 20TH ST
BELLEVUE WA
98004-3005
US

V. Phone/Fax

Practice location:
  • Phone: 425-462-2531
  • Fax: 425-454-6176
Mailing address:
  • Phone: 425-462-2531
  • Fax: 425-454-6176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00028590
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD00028590
License Number StateWA

VIII. Authorized Official

Name: SUE ROMANICK
Title or Position: OWNER
Credential: MD
Phone: 425-462-2531