Provider Demographics
NPI:1962401778
Name:DELBECCARO, KATHRYN H (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:H
Last Name:DELBECCARO
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 1:7554 15TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5409
Mailing Address - Country:US
Mailing Address - Phone:206-783-9300
Mailing Address - Fax:206-789-8404
Practice Address - Street 1:7554 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-5409
Practice Address - Country:US
Practice Address - Phone:206-783-9300
Practice Address - Fax:206-789-8404
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00021823208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1032630Medicaid