Provider Demographics
NPI:1104445444
Name:POLITO, DAVID STEPHAN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:STEPHAN
Last Name:POLITO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 NE PACIFIC STREET
Mailing Address - Street 2:NW011; MAILING ADDRESS: BOX 357233
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-0001
Mailing Address - Country:US
Mailing Address - Phone:206-598-5130
Mailing Address - Fax:206-598-8475
Practice Address - Street 1:1959 NE PACIFIC STREET
Practice Address - Street 2:NW011; MAILING ADDRESS: BOX 357233
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-2908
Practice Address - Country:US
Practice Address - Phone:206-598-5130
Practice Address - Fax:206-598-8475
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.0773362085R0202X
390200000X
WAMD.MD.616810232085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program