Healthcare Provider Details

I. General information

NPI: 1982870796
Provider Name (Legal Business Name): THERESA A BURDICK MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BROADWAY SUITE 707
SEATTLE WA
98122
US

IV. Provider business mailing address

801 BROADWAY SUITE 707
SEATTLE WA
98122
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-3605
  • Fax: 206-254-9220
Mailing address:
  • Phone: 206-386-3605
  • Fax: 206-254-9220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD00016175
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMD00016175
License Number StateWA

VIII. Authorized Official

Name: THERESA A BURDICK
Title or Position: PRESIDENT PHYSICIAN
Credential: MD
Phone: 206-368-3605