Healthcare Provider Details

I. General information

NPI: 1861560229
Provider Name (Legal Business Name): LELACH RAVE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

4776 34TH AVE NE
SEATTLE WA
98105-4007
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-0000
  • Fax:
Mailing address:
  • Phone: 206-403-6105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00043917
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberMD00043917
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: