Healthcare Provider Details

I. General information

NPI: 1225148539
Provider Name (Legal Business Name): SUSAN MARGARET HALBACH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST C-212, BOX 356340
SEATTLE WA
98195-6340
US

IV. Provider business mailing address

4800 SAND POINT WAY NE A-7932
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-0065
  • Fax:
Mailing address:
  • Phone: 206-987-2524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberMD 00048452
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: