Healthcare Provider Details

I. General information

NPI: 1891426243
Provider Name (Legal Business Name): PRIYANKA RAJU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MADISON ST STE 510
SEATTLE WA
98104-3557
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 206-991-2000
  • Fax: 206-991-2005
Mailing address:
  • Phone: 206-320-4476
  • Fax: 206-568-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD70106970
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: