Healthcare Provider Details

I. General information

NPI: 1245546092
Provider Name (Legal Business Name): ELIZABETH GRACE ALTOMARE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH GRACE DOUGLAS M.D.

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7530 164TH AVE NE STE A215
REDMOND WA
98052-7809
US

IV. Provider business mailing address

2475 140TH AVE NE
BELLEVUE WA
98005-1892
US

V. Phone/Fax

Practice location:
  • Phone: 425-885-9292
  • Fax:
Mailing address:
  • Phone: 425-460-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101252989
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57092
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: