Provider Demographics
NPI:1245546092
Name:ALTOMARE, ELIZABETH GRACE (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:GRACE
Last Name:ALTOMARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:GRACE
Other - Last Name:DOUGLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2475 140TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1892
Mailing Address - Country:US
Mailing Address - Phone:425-460-5600
Mailing Address - Fax:
Practice Address - Street 1:7530 164TH AVE NE STE A215
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-7809
Practice Address - Country:US
Practice Address - Phone:425-885-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101252989208000000X
390200000X
AZ57092208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ57092OtherARIZONA MEDICAL BOARD
1245546092OtherNPI