Healthcare Provider Details

I. General information

NPI: 1669596615
Provider Name (Legal Business Name): SUSANNAH I TAYLOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE BOX 359755
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

325 9TH AVE BOX 359755
SEATTLE WA
98104-2420
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-9102
  • Fax: 206-744-9976
Mailing address:
  • Phone: 206-744-9102
  • Fax: 206-744-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00027533
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: