MEDICARE: RICHARD E SEROUSSI 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	208100000X	Physical Medicine & Rehabilitation Physician	MD00031281	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	158738	OTHER	WA	LABOR & INDUSTRIES
2	9006SE	OTHER	WA	REGENCE RIDER NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992722698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD E SEROUSSI MD

Provider Business Mailing Address
First Line	:	3213 EASTLAKE AVE E
Second Line	:	SUITE A
City	:	SEATTLE
State	:	WA
Zip	:	98102-3826
Country	:	US
Telephone Number	:	206-861-8200
Fax Number	:	206-324-1178

Provider Business Practice Location Address
First Line	:	3213 EASTLAKE AVE E
Second Line	:	SUITE A
City	:	SEATTLE
State	:	WA
Zip	:	98102-3826
Country	:	US
Telephone Number	:	206-861-8200
Fax Number	:	206-324-1178

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	12/17/2018

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