Healthcare Provider Details

I. General information

NPI: 1003895012
Provider Name (Legal Business Name): ROANNE R E SELINGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 116TH AVE NE #560
BELLEVUE WA
98004
US

IV. Provider business mailing address

1135 116TH AVE NE STE 560
BELLEVUE WA
98004-4631
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-4768
  • Fax: 425-462-8021
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number38780
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: