MEDICARE: AUDREY YOUNG CRISSMAN 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	207R00000X	Internal Medicine Physician	MD00040205	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110239573	OTHER	WA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	185190	OTHER		INTERNAL ID-MOTOR VEHICLE ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982761110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY YOUNG CRISSMAN MD

Provider Business Mailing Address
First Line	:	3216 NE 45TH PL STE 301
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-4028
Country	:	US
Telephone Number	:	206-339-3360
Fax Number	:	206-212-1100

Provider Business Practice Location Address
First Line	:	3216 NE 45TH PL STE 301
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-4028
Country	:	US
Telephone Number	:	206-339-3360
Fax Number	:	206-212-1100

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	08/16/2024

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Directions to “ AUDREY YOUNG CRISSMAN MD” Practice Location

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