Provider Demographics
NPI:1194751719
Name:WANI, ROOHI H (MD)
Entity type:Individual
Prefix:
First Name:ROOHI
Middle Name:H
Last Name:WANI
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 1:20508 NE 23RD CT
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-4385
Mailing Address - Country:US
Mailing Address - Phone:425-885-3099
Mailing Address - Fax:
Practice Address - Street 1:20508 NE 23RD CT
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-4385
Practice Address - Country:US
Practice Address - Phone:425-885-3099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044483207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00341381OtherMEDICARE ID UNSPECIFIED
WA8861724Medicare PIN