Healthcare Provider Details

I. General information

NPI: 1790878361
Provider Name (Legal Business Name): RAJ P. KAPUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

6829 27TH AVE NE
SEATTLE WA
98115-7140
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2103
  • Fax: 206-987-3840
Mailing address:
  • Phone: 206-363-3881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License NumberMD00027741
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: