Healthcare Provider Details

I. General information

NPI: 1912162538
Provider Name (Legal Business Name): LUSINE AMBARTSUMYAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 07/25/2013
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

4800 SAND POINT WAY NE W-7830, PO BOX 5371
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2587
  • Fax: 206-987-2721
Mailing address:
  • Phone: 206-987-2587
  • Fax: 206-987-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberMD 60340693
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: