MEDICARE: WORAWAN RATTANASAMPHAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MD00045055	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1073574471	OTHER	WA	NPI
2	MD00045055	OTHER	WA	LICENSE

General Provider Information

NPI Number	:	1073574471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WORAWAN RATTANASAMPHAN MD

Provider Business Mailing Address
First Line	:	1750 112TH AVE, NE
Second Line	:	SUITE A-101
City	:	BELLEVUE
State	:	WA
Zip	:	98008
Country	:	US
Telephone Number	:	425-688-5234
Fax Number	:	425-688-5756

Provider Business Practice Location Address
First Line	:	1750 112TH AVE NE
Second Line	:	SUITE A-101
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3752
Country	:	US
Telephone Number	:	425-688-5234
Fax Number	:	425-688-5756

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	03/07/2023

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