Provider Demographics
NPI:1306932165
Name:DALLEY, ROBERTA W (MD)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:W
Last Name:DALLEY
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:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-543-6420
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST, U OF WASHINGTON MEDICAL CTR
Practice Address - Street 2:RADIOLOGY, ROOM RR-215, BOX 357115
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-543-3320
Practice Address - Fax:206-543-6317
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000246642085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1306932165Medicaid
WA0230938OtherL&I
WA0230938OtherL&I
WA1306932165Medicaid