Healthcare Provider Details

I. General information

NPI: 1154447217
Provider Name (Legal Business Name): GERARD ZANOLLI MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5236 CALIFORNIA AVE SW SUITE B
SEATTLE WA
98136-1244
US

IV. Provider business mailing address

5236 CALIFORNIA AVE SW SUITE B
SEATTLE WA
98136-1244
US

V. Phone/Fax

Practice location:
  • Phone: 206-938-4200
  • Fax:
Mailing address:
  • Phone: 206-938-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00034812
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD00034812
License Number StateWA

VIII. Authorized Official

Name: DR. GERARD M. ZANOLLI
Title or Position: OWNER
Credential: M.D.
Phone: 206-938-4200