Provider Demographics
NPI:1861557126
Name:HUANG, DEBORAH L (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:HUANG
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 1:4245 ROOSEVELT WAY NE
Practice Address - Street 2:MAILSTOP 354765
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-6008
Practice Address - Country:US
Practice Address - Phone:206-598-5500
Practice Address - Fax:206-598-8722
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044225207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8418022Medicaid
WA1861557126Medicaid
WAG8851083Medicare PIN
WAG8851082Medicare PIN
WA8418022Medicaid
WAG8851084Medicare PIN
WAG8872384Medicare PIN
WAG8851080Medicare PIN
WA8923445Medicare UPIN
SCG8851082Medicare PIN
WAI24604Medicare UPIN