Healthcare Provider Details

I. General information

NPI: 1689735730
Provider Name (Legal Business Name): SUSAN M. O'BRIEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16251 SYLVESTER RD SW HIGHLINE MEDICAL CENTER ED
BURIEN WA
98166-0657
US

IV. Provider business mailing address

1118 DUCHESS RD
BOTHELL WA
98012-7039
US

V. Phone/Fax

Practice location:
  • Phone: 206-421-5316
  • Fax:
Mailing address:
  • Phone: 426-488-1142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD00029277
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberMD00029277
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: