Provider Demographics
NPI:1063592368
Name:DOROSHOW, CAROL A (MD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:DOROSHOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 FREMONT AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7225
Mailing Address - Country:US
Mailing Address - Phone:206-957-1881
Mailing Address - Fax:206-957-1895
Practice Address - Street 1:4411 FREMONT AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7225
Practice Address - Country:US
Practice Address - Phone:206-957-1881
Practice Address - Fax:206-957-1895
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020986208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1072255Medicaid
WA6585DOOtherREGENCE
WA4215844OtherAETNA
WAP594301OtherPREMERA
WA800274OtherFIRST HEALTH
WAA09275Medicare UPIN