Healthcare Provider Details

I. General information

NPI: 1386404465
Provider Name (Legal Business Name): MADISON LEIGH PELTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE OC.7.830
SEATTLE WA
98105
US

IV. Provider business mailing address

4800 SAND POINT WAY NE OC.7.830
SEATTLE WA
98105
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberML61544715
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: