Provider Demographics
NPI:1306893276
Name:KRAEMER, DIANA ABSON (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:ABSON
Last Name:KRAEMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DIANA
Other - Middle Name:KRAEMER
Other - Last Name:ABSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:801 PINE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1852
Mailing Address - Country:US
Mailing Address - Phone:206-226-9183
Mailing Address - Fax:206-260-7511
Practice Address - Street 1:801 PINE ST STE 100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1852
Practice Address - Country:US
Practice Address - Phone:206-226-9183
Practice Address - Fax:206-260-7511
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029598207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1074970Medicaid
WA1074970Medicaid