MEDICARE: DR. DAVID STEPHAN POLITO 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	2085R0202X	Diagnostic Radiology Physician	125.077336	IL
2	390200000X	Student in an Organized Health Care Education/Training Program
3	2085R0202X	Diagnostic Radiology Physician	MD.MD.61681023	WA

General Provider Information

NPI Number	:	1104445444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID STEPHAN POLITO MD

Provider Business Mailing Address
First Line	:	1959 NE PACIFIC STREET
Second Line	:	NW011; MAILING ADDRESS: BOX 357233
City	:	SEATTLE
State	:	WA
Zip	:	98195-0001
Country	:	US
Telephone Number	:	206-598-5130
Fax Number	:	206-598-8475

Provider Business Practice Location Address
First Line	:	1959 NE PACIFIC STREET
Second Line	:	NW011; MAILING ADDRESS: BOX 357233
City	:	SEATTLE
State	:	WA
Zip	:	98195-2908
Country	:	US
Telephone Number	:	206-598-5130
Fax Number	:	206-598-8475

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

Provider Enumeration Date	:	04/15/2020
Last Update Date	:	04/27/2025

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