Healthcare Provider Details

I. General information

NPI: 1477781532
Provider Name (Legal Business Name): ANGELA MARIE TRIPP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 NE BLAKELY DR SUITE 4020
ISSAQUAH WA
98029-6201
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 425-498-2272
  • Fax: 425-498-2334
Mailing address:
  • Phone: 206-320-4476
  • Fax: 425-498-2334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2009011483
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD60343585
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: