MEDICARE: SUSAN S BLOCK 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	207V00000X	Obstetrics & Gynecology Physician	MD00031154	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	160053497	OTHER	WA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	151210	OTHER	WA	L & I
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285621771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN S BLOCK MD

Provider Business Mailing Address
First Line	:	515 MINOR AVE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98104-2120
Country	:	US
Telephone Number	:	206-386-9500
Fax Number	:	206-576-3802

Provider Business Practice Location Address
First Line	:	1229 MADISON ST
Second Line	:	STE 1500
City	:	SEATTLE
State	:	WA
Zip	:	98104-3586
Country	:	US
Telephone Number	:	206-386-9500
Fax Number	:	206-576-3802

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	05/02/2012

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Directions to “ SUSAN S BLOCK MD” Practice Location

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